ORAL ANSWERS TO QUESTIONS

ENERGY AND CLIMATE CHANGE

The Secretary of State was asked—

Household Energy Bills

Mike Kane: What steps he is taking to help households with their energy bills.

David Hanson: What steps he is taking to help households with their energy bills.

Geoffrey Robinson: What steps he is taking to help households with their energy bills.

Pamela Nash: What steps he is taking to help households with their energy bills.

Andrew Miller: What steps he is taking to help households with their energy bills.

Edward Davey: Energy bills remain a worry for many, so we have three main ways of helping households: giving direct financial help, promoting competition and enabling energy efficiency. Our financial help includes the £2.15-billion winter fuel allowance for pensioners, and more than £31 million will be spent this winter on providing assistance to more than 2 million low-income and vulnerable households. Although there remains room for improvement, energy markets are more competitive than they were in 2010, enabling many people to save around £300 a year by switching supplier. Our energy efficiency policies, which provide permanent cuts to bills, have improved the energy efficiency of more than 1 million homes, enabling us to meet our target earlier than expected.

Mike Kane: There is indeed room for improvement. The Children’s Society tells me that there are 2,200 children in families that are trapped in energy debt in my constituency of Wythenshawe and Sale East, yet Which? says that given the global changes in commodity prices, energy companies could be driving down household bills by £164; does the Minister agree with it?

Edward Davey: I certainly agree with Which?, which has welcomed the referral of the energy market to the Competition and Markets Authority—something that we have backed. The Leader of the Opposition, when he was doing my job, failed to back such a referral on three occasions. It is vital that the cuts in wholesale costs are passed to consumers, and we are on it.

David Hanson: The Children’s Society tells me that there are 3,300 children in families that are in energy debt in my constituency, yet only last week, Ofgem estimated that household bills could be cut by £114 because of the cost of energy. Why will the Secretary of State not give Ofgem the power to cut bills when they are that high?

Edward Davey: The problem with the Opposition’s policy is that if we had listened to them and frozen bills, people would now have even higher bills and would be in even more debt. We are not going to listen to the Opposition’s failed energy policy. Our policy has seen bills come down, not just frozen. People can get some of the best deals by switching to the independents that we have encouraged into the market.

Mr Speaker: I call Mr Geoffrey Robinson. Not here.

Pamela Nash: With the news this week that price comparison sites do not always show customers the cheapest offers because they would not get their share, and given that switching is so crucial to the Government, is it not time that we had a non-commercial Government comparison site?

Edward Davey: The hon. Lady raises an important question, because it is vital that consumers can switch with confidence. That is why I am pleased that Ofgem has decided to toughen up the confidence code for the accreditation of switching sites. That will be a big step forward.

Andrew Miller: The report to which my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) and my right hon. Friend the Member for Delyn (Mr Hanson) referred shows that 2,300 children in my constituency live in families that have energy debt. Equally, at the other end of the spectrum, many of the high-energy businesses that sustain some of the most valuable jobs in my constituency are struggling because of this policy. What sort of policy is it that creates failure at both ends of the market?

Edward Davey: I disagree that the policy is creating failure, but I agree with the hon. Gentleman and other Opposition Members that high energy bills need to be dealt with. The question is what the best way of dealing with them is. We have been dealing with them every single day since I took office by using competition, energy efficiency and direct financial support, and by helping energy-intensive industries. Our policies are working. Frankly, if we had listened to the Opposition, people would be paying higher energy bills.

Tim Yeo: Does the Secretary of State agree that transmission and distribution charges account for more than a fifth of many household bills? Will he press Ofgem to bear down more toughly on the charges made by the monopoly transmission company, National Grid, and by near-monopoly distribution companies all over the country?

Edward Davey: My hon. Friend is right that network costs account for about a fifth of the average household bill. Of course, the Energy and Climate Change Committee, which he chairs, is looking into this issue and has taken evidence on it. We look forward to receiving his report. If one looks at an historical analysis of network costs as a proportion of energy bills, they have been coming down steeply since privatisation. We obviously want Ofgem to continue to bear down on them, and our regulatory regime is one of the strongest in the world.

Steven Baker: My right hon. Friend the Secretary of State has already explained the incompetence of a price freeze. Does he agree that the best way to help families is to use the traditional liberal approach of competition to drive down prices?

Edward Davey: My hon. Friend is right: a liberal approach is definitely the best. In the spirit of the coalition, we have together managed to bring down energy bills by reducing policy costs by £50, something opposed by Labour. It is often forgotten that because we have liberal markets in Britain, the UK enjoys the lowest domestic gas prices in the EU15.

Caroline Lucas: New research shows an 80% fall in insulation measures for fuel-poor homes under the coalition. While the Secretary of State desperately spins about having helped 1 million households, the facts show that had the Government not weakened their policies, nearly 3 million homes would have been helped by now. When will he make energy efficiency a top infrastructure priority with the funds to match?

Edward Davey: I am grateful for the hon. Lady’s question, although I do not recognise her figures. Energy efficiency is a top priority for the Government, and I hope that she will welcome the fact that yesterday I laid before Parliament new regulations to require landlords in the private sector to meet minimum energy efficiency standards by 1 April 2018. That will help 1 million tenants in the most energy-inefficient houses in the country.

Alan Duncan: Is not the last thing that will help household energy bills a policy that freezes prices at a level above the market, the mere announcement of which—even while the proposers are in opposition—has had a detrimental effect, distorting the markets before the policy is even implemented?

Edward Davey: My right hon. Friend is right. The evidence is clear, not just to everyone in this House, but to every voter: if we had implemented Labour’s proposal, people would be paying higher energy bills now.

Julie Elliott: This week, the consumer body Which? added to the growing body of evidence that energy companies do not pass on reductions in wholesale costs to their consumers. Which? confirmed that cuts to consumer bills should have been larger and made far sooner. Does the Secretary of State regret that he voted as recently as last month not to back Labour’s plan to give the energy regulator the power to cut energy prices when wholesale costs fall?

Edward Davey: This is a very important issue, and when I considered it last year, I looked at the record of a predecessor of mine as Secretary of State—now the Leader of the Opposition—when wholesale prices fell far faster and further. He did nothing. We have acted all the way. I agree with much of the analysis by Which?, especially on the need to work even harder to make our markets more competitive. The markets we inherited in 2010, with Labour’s big six, needed reform. We have undertaken that reform, and that is why the big six’s market share has fallen so significantly, and why we have backed, unlike Labour, a reference to the independent competition authority, so it can look at the energy market.

Julie Elliott: As usual, the Secretary of State did not answer the question. Will he explain why Ofgem estimated only last week that profit margins for the big energy companies are set to soar to £114 per household, citing expected future falls in wholesale costs as the reason for the increase? Is that what a functioning, competitive market looks like?

Edward Davey: Of course we all want to see falling prices, not increased profits, and that is one of the reasons why we are increasing competition. It is ironic that Labour is now quoting Ofgem—the regulator it introduced, tried to improve and now wants to abolish. The hon. Lady and her party must come behind our policy of increased competition, must start backing the Competition and Markets Authority reference, and should change their policy in the face of the evidence. They should say that they will abide by the recommendations of the CMA and will stop playing party politics with a very serious issue.

Gerald Kaufman: rose—

Mr Speaker: Order. It is always a pleasure to hear the right hon. Gentleman, but his question is in a later group. We are saving him for the delectation of the House at a later stage in our proceedings.

Gerald Kaufman: I am grateful to you for that guidance, Mr Speaker. I received a letter from the Department yesterday saying that my question, which was then question 22, was linked with question 5, tabled by my hon. Friend the Member for Coventry North West (Mr Robinson). The Department has created great confusion which you, Mr Speaker, with your usual efficiency and consideration, are clearing up.

Mr Speaker: I am extremely grateful to the right hon. Gentleman. All compliments gratefully accepted.

Renewable Energy

Andrew Robathan: What estimate he has made of the proportion of electricity demand that will be met by renewable energy in 2015 compared with 2010.

Matthew Hancock: We have doubled the amount of renewable energy from 6.8% of electricity in 2010 to more than 14% of electricity generation.

Andrew Robathan: So it is true: this is the greenest Government ever. Will my right hon. Friend tell us what proportion of that electricity is generated by onshore wind? Can he confirm that onshore wind is the most mature, least expensive, and most efficient form of renewable energy, and is actually pretty popular?

Matthew Hancock: A high proportion of electricity is from onshore wind, but there is also solar—one million people now live in households with solar panels on their roofs—and offshore wind, which plays an important role. We will continue to have a strong energy mix, with a strong performance from renewables, to ensure that we deliver on our pledge, which we are committed to and are fulfilling, to be the greenest Government ever.

Barry Sheerman: The Minister knows that some Liberal Democrat voices in the Government are keen on this being a green Government, but the fact is that there are climate change deniers in his own party in other Departments. Every time wind power is brought in, it is knocked down by the Secretary of State for Communities and Local Government. The Minister knows there is a subversive element in the Government who hate anything to do with renewable energy.

Matthew Hancock: The hon. Gentleman is normally quite sensible, and I normally agree with him, but subversive elements are certainly not part of the current Government, as we can tell from our record. The proportion of electricity generated from renewables has doubled under this Government. We are committed to ensuring that renewables play a big part of the mix in the most cost-effective way that they can.

James Gray: Will the Minister join me in congratulating Wiltshire council, which has already achieved its 2020 renewables target through a whole variety of means? Does he agree that that achievement ought to be a substantive consideration when the Planning Inspectorate decides on further applications for solar on greenfield sites?

Matthew Hancock: I know my hon. Friend has a concern about solar panels being put in inappropriate places. There are appropriate places for solar to go, especially on roofs and in brownfield sites. That is, of course, a matter for a strong planning system, in which those local decisions are rightly made, but that does not take away from the fact that we have so much more renewable energy than we did just five short years ago.

Dennis Skinner: On the subject of the energy mix, which the Minister referred to, is he aware that we would not be discussing this question of wind power had not the Tories shut more than 100 pits after 1984? There are three of them left. We had a big march in Kellingley on Saturday, and more than 500 people from Thoresby and Hatfield turned up demanding the state aid that he has promised for several weeks at that Dispatch Box. Will he now state emphatically that he will apply for state aid to keep those three pits open, so that they can exhaust their reserves and enable those 3,000 miners to keep their jobs? That’s energy mix—get on with it.

Matthew Hancock: I admire the hon. Gentleman’s ability to get a question on coal into one on the Order Paper about renewables. I come from coal mining stock, and I have delivered support to the three remaining deep pits so far to make sure they stay open on a commercial basis, and to ensure, as far as possible within the constraints of affordability and value for money, the continuation of this mining. There is nobody who has done more than me in the past six months to make this happen. I will continue to work with all parties, including the National Union of Mineworkers, to get there.

Mr Speaker: Never use one word where 100 will do. I call Jim Shannon.

Jim Shannon: To change the question slightly, one area in which there could be improvement is in encouraging industry to move from electricity to more renewable sources for heat and energy. Is the target of 20% being met, and what discussions has the Minister had with his equivalent in the Northern Ireland Assembly, Arlene Foster, to ensure that these targets are met across the whole United Kingdom?

Matthew Hancock: If I may say so, that was a rather better question than the previous one. This is an important issue. We are working with our colleagues in Northern Ireland at an official level and throughout the Government to deliver on the commitments made, and it is important that we continue to do so.

Solar Power Panels (Installation)

Graham Allen: What assessment he has made of the effect of recent changes to the incentive scheme for installing solar power panels on businesses that install those panels.

Amber Rudd: Solar PV has been a major success story, with the most recent deployment figures showing a total of 5 GW of capacity across the UK, 99% of which has been put in place under this Government. The solar strategy, published last spring, set out a range of actions that will allow more businesses to enjoy reduced energy bills through installing solar PV. The changes we have made, financial and non-financial, for solar PV will make it an affordable part of our low-carbon energy mix, and we anticipate that splitting the feed-in tariff will promote rooftop solar, particularly at industrial premises.

Graham Allen: Unfortunately, I do not have many small businesses in my constituency, so it is a tragedy when I lose one; losing MG Renewables, which had invested in a fleet of vehicles, was a matter of great regret. Will the Minister reassure the House that we will have a steady and clear set of incentives, rather than this constant changing, which makes it particularly difficult for small businesses to plan and maintain their viability? Will she talk to the Treasury and the Department for Business, Innovation and Skills to ensure that?

Amber Rudd: Small businesses are essential to economic growth, and we are determined to support them. I understand the hon. Gentleman’s point, which is about the support for solar through our feed-in tariffs. Owing
	to the reducing capital costs of solar, we have reduced the support. It is essential that we strike the right balance between using taxpayers’ money and supporting businesses, but I appreciate his point and will bear it in mind.

Peter Lilley: Given that we are constantly told that the reducing costs of solar panels will soon render them competitive with conventional electricity, why do we not abolish subsidies completely? Or do Ministers not believe their own projections?

Amber Rudd: My right hon. Friend is entirely right. The reduction in cost and the success of solar PV mean that, according to the industry itself, it will become subsidy free, we hope, by the end of the decade. That is because of investment under this Government. It will be something to celebrate, and something that the taxpayer, as well as everyone in the Government, will appreciate.

Ian Lavery: There are some excellent energy companies springing up in my constituency, such as Saving Energy Renewables, a PV solar panel firm, but projects are stalling because of the low-grade capacity for exporting energy from the systems. What can the Government do to ensure that companies can connect these systems and make serious contributions to both rooftop solar and deployment as part of the solar road map laid out by this Government?

Amber Rudd: Solar is an essential part of the renewable energy mix; the hon. Gentleman is entirely right. We continue to look at this under the community energy strategy, and hope to develop plans to help deliver the sorts of projects he mentioned.

Wind Power

Douglas Carswell: What estimate he has made of the proportion of electricity consumption that will be sourced from wind by 2017.

Amber Rudd: Electricity consumed in the UK comes from a range of sources. In 2013, 35% came from coal, 27% from gas, 18% from nuclear and 15% from renewables, including wind generation. The “Electricity Market Reform Delivery Plan”, published in December 2013, stated our aim of achieving total UK renewable deployment of around 43 GW by 2020, which would generate about 109 TWh.

Douglas Carswell: Given that the Minister cannot possibly know how windy it will be in 2017—there are huge variations in these things—or the relative price of different methods of energy generation this year, let alone in 2017, why not scrap the wind subsidies to the big corporations and allow energy producers to compete freely and produce energy at a price householders are willing to pay? Surely that would give people a much better deal.

Amber Rudd: Wind is an essential part of the renewables mix. I appreciate the hon. Gentleman’s point that it is not 100% reliable—the wind does not always blow—but
	that is why it is part of the energy mix and is supported by other energy sources. We are continuing as a Department to invest in the battery industry and we hope that when that industry develops we will be able to find wind more reliable, with the subsidies coming down accordingly.

David Jones: Transmission lines from large wind farms such as Clocaenog in my constituency can have a severely detrimental effect on the lives of residents in the locality. What consideration has my hon. Friend given to requiring the heavily subsidised developers of those wind farms to pay for installing those lines underground?

Amber Rudd: It is an interesting question. The National Grid is responsible for surveying and implementing these matters, in conjunction with the Planning Inspectorate, and it will be for them to take that into consideration, if appropriate, for the different wind farms.

Offshore Wind

Jim McGovern: What steps he is taking to promote and ensure the viability of the UK's offshore wind sector.

Amber Rudd: The UK has the most fully installed, operational offshore wind capacity in the world and is consistently rated the No. 1 market for investment attractiveness. The Government are supporting significant levels of offshore wind deployment which will deliver the volume necessary to help achieve cost reduction and give the supply chain the confidence to invest. The competitive contracts for difference process will also reduce cost to ensure greater scale of delivery.

Jim McGovern: Last year, despite assurances from the then First Minister of Scotland, Alex Salmond that there would be an offshore wind development in Dundee that would have brought 700 jobs to the city, SSE withdrew the plans. Does the Minister agree that Scotland cannot rely entirely on gas and oil for its economy and cannot rely on the separatists to bring renewables to Scotland?

Amber Rudd: I agree that renewables are part of the energy mix and must be stimulated and grown in conjunction with existing energy supplies. The Scottish Government already have the responsibility for consenting to and licensing offshore wind. When the Smith commission proposals are implemented, the Scottish Government will also assume the Crown Estate’s existing role as landlord. That will give them the ability to offer more areas in Scottish waters for offshore renewable development should they wish to do so. I suggest he continues to take the issue up with the Scottish Government.

Ian Swales: In a recent written answer the Minister told me that
	“it is a priority for Government to support the development of a UK-based supply chain for offshore wind and to increase the UK content of wind farms ”,
	but that she does not require developers to report on UK content. Companies in the north-east, such as Deep Ocean in Darlington, that have already invested over £400 million in production and installation facilities
	want to know why her Department is not being more proactive in ensuring UK companies benefit fully from this taxpayer-subsidised activity.

Amber Rudd: My hon. Friend has raised a specific question. My broad answer is that we need a supply chain plan in place. If he would be kind enough to write to me specifically about that matter, I will take a particular interest in it.

Michael Weir: Notwithstanding what the Minister says about the licensing of offshore, the fact is that the financing of it is through the contracts for difference. Given that there is a four to five-year horizon between being granted a CfD and the commissioning of the first turbines, offshore developers have expressed concern over the levy control framework and, in particular, what they perceive as a budgetary cliff in 2020, with no indication of what comes thereafter. Is the Minister intending to meet developers to give them any confidence that there will be continued CfDs available after 2020?

Amber Rudd: There is more visibility about funding offshore wind in this country than anywhere in the world. We are keen to continue that, so that we are No. 1 for offshore wind. I will continue to make everyone aware of our plans. For 2020, we certainly hope that we will be in a position to do that. As the hon. Gentleman is aware, the current CfD winners will be informed on 26 February. We will all be interested in the outcome.

Nicholas Dakin: May I press the Minister a little further on the steps that the Government will take to ensure that there is significant local content in the materials used to build these wind turbines?

Amber Rudd: To get a CfD one has to have a supply chain plan in place, so we hope that that will reinforce the need to have local support and an effective
	local supply chain.

Energy Efficiency

Andrew Gwynne: What steps he is taking to help households improve their energy efficiency.

Joan Walley: What steps he is taking to help households improve their energy efficiency.

Barry Gardiner: What steps he is taking to help households improve their energy efficiency.

Alex Cunningham: What steps he is taking to help households improve their energy efficiency.

Gerald Kaufman: What steps he is taking to help households improve their energy efficiency.

John Robertson: What steps he is taking to help households improve their energy efficiency.

Edward Davey: We have extended our successful energy companies obligation to 2017 and reformed the green deal with changes such as the green deal home improvement fund. Together, ECO and the green deal have helped more than 1 million homes become more energy efficient. As I have said, I laid regulations before Parliament yesterday to require landlords to bring their properties up to a minimum level of energy efficiency by 1 April 2018. If the House agrees these new, tough rules for the private rented sector, we estimate that around 1 million tenants will benefit from warmer and cheaper-to-heat homes.

Andrew Gwynne: It was almost two years ago that the then Energy Minister, the right hon. Member for Bexhill and Battle (Gregory Barker) said that he would be having sleepless nights if fewer than 10,000 people signed up for the green deal. Since then, 5,000 people have benefited from the measures—that is all. For how long is the Secretary of State seriously going to insult the intelligence of Members by saying that the green deal has been a success?

Edward Davey: Not for the first time, the hon. Gentleman is wrong with his statistics. More than 445,000 green deal assessments have taken place, and our evidence shows that over 70%—[Interruption]—over 70% of those people having assessments go on to install measures or intend to install measures. That is far more than the hon. Gentleman talks about. For the benefit of the House, let me clarify that the figures he used relate to people who have gone through the system and used green deal finance—only one part of the green deal. Green deal assessment is a key part: it has been working and it has played forward to enable us to meet our target for insulating 1 million homes four months ahead of schedule.

Joan Walley: I ask the Secretary of State to revisit the figures. He is making great play of them, but 80% fewer people had energy efficiency schemes last year in comparison with 2011-12. Rather than just trade figures, is it not time that the Secretary of State really looked at putting energy efficiency at the heart of his energy investment infrastructure policy?

Edward Davey: Let me reassure the hon. Lady that energy efficiency is at the heart of our policies. That is why we have managed to achieve our 1 million target early, and why I have put forward legislation for the private rented sector, which I hoped the hon. Lady would welcome. She might be interested to know that today John Alker, acting chief executive officer of the UK Green Building Council said:
	“This could be the single most significant piece of legislation to affect our existing building stock in a generation”.
	I am proud that this Government have introduced that.

Barry Gardiner: What specific energy efficiency measures has the UK proposed should be included in the European INDC—intended nationally determined contributions—and how will the Secretary of State ensure that, unlike the domestic green deal, a rate of success is not promised in one year when less than half of it has been achieved in two?

Edward Davey: I think the hon. Gentleman is muddling a few things. I talked to Commissioner Miguel Cañete, who showed me the draft of the EU’s INDC—and I am afraid that it is rather more high level than the hon. Gentleman suggests. The EU’s INDC will, I think, be published and go to the Energy Council or perhaps the Environment Council at the end of this month, and it will not go into that level of detail. The hon. Gentleman might want to take up his point with the Commissioner.

Alex Cunningham: Government data show that more than 16,000 households in the north-east of England have spent in total £1.6 million on green deal assessments, but that only 140 have benefited from energy efficiency measures costing £500,000—a net loss of £1.1 million for householders. Will the Minister just face the facts and admit that the green deal is simply not working?

Edward Davey: I do not recognise the hon. Gentleman’s figures. Let me gently tell him that the figures he mentions relate to people who invested in the green deal following the original assessment, and people might not have used green deal finance as a way of financing their investment. All the evidence shows that many people are using their own finances and savings; for some, it is a remortgage, and others are borrowing in other ways. I would have thought that what the hon. Gentleman, I and the whole House would be interested in is improving the nation’s building stock—not whether people use a particular form of consumer credit.

Gerald Kaufman: Given that energy efficiency is an important weapon for combating climate change, and given that it also lowers the energy bills of householders —particularly those on low incomes—has not the Government’s institutional meddling with energy efficiency structures not only wasted a huge amount of taxpayers’ money but actually made people on lower incomes pay more? Is not the Secretary of State’s green deal nothing but a pack of cards that contains only jokers?

Edward Davey: I enjoyed the first half of that question, but it deteriorated into inaccuracy rather rapidly. I am afraid that the facts are against the right hon. Gentleman. Green deal assessments have been carried out for more than 445,000 people, and figures show that more than 70% of those people have subsequently installed energy efficiency measures. Furthermore, as a result of the combination of the green deal and the energy companies obligation, more than 1 million homes had benefited from such measures by the end of November. I should have thought that the right hon. Gentleman would welcome the huge success of a scheme that is permanently reducing the energy bills of so many people, and I might have hoped that he would welcome the fact that the private rented sector regulations that we are introducing today will help many tenants in his constituency.

John Robertson: Energy efficiency has done absolutely nothing for people who are in fuel poverty. Estonia is the only country in Europe with a higher proportion of its population in fuel poverty than Britain. I invite the Secretary of State—and I mean this helpfully—to come to my constituency, so that I can show him exactly what I am talking about. He obviously does not believe
	anything that he hears from Opposition Members, but if he comes to Glasgow, we can meet and I can show him.

Edward Davey: I am always keen to listen to the hon. Gentleman. As he knows, I have read the report that he wrote on prepayment meters and their users, and am responding to it. However, his analysis of fuel poverty was wrong on at least two counts. First—as he will see when we publish our poverty strategy shortly—the energy companies obligation, along with other measures that we have taken, has already helped many fuel-poor households during the current Parliament, Those measures are a significant step forward. Secondly, the way in which we are reforming those measures is helping even more people.
	The hon. Gentleman suggested that Estonia was the only EU country with a higher proportion of people in fuel poverty than Britain. I do not know whether he has looked at the way in which the EU and individual EU member states compile fuel poverty statistics, but I do not think that it enables him to reach that conclusion.

Anne McIntosh: I, for one, congratulate the Secretary of State and welcome the new regulations, which will bring relief to many people living in poorly insulated rented accommodation in my area. However, may I press him to define the minimum level of energy efficiency more clearly?

Edward Davey: I am delighted that the hon. Lady welcomes the new regulations, which will make a significant difference by requiring landlords to raise the energy performance certificate rating of their properties to a minimum of band E by 1 April 2018. We believe that that will help about 1 million tenants over the next three years.

Annette Brooke: Given that this is a particularly cold week, may I remind the Secretary of State of the people who live in park homes? Will he support the call by the park home owners justice campaign for a dedicated, fully funded insulation programme? Is it not time for action, rather than mere consultation?

Edward Davey: My hon. Friend has been a doughty champion of park home owners. As she knows, we have been the first Government to engage with some of the challenging issues that they face. She will know, for example, that our reform of the warm home discount will make many park home owners eligible for it for the first time. That is action. As for the insulation programme that she mentioned, if she can wait until we publish our fuel poverty strategy, she will see that we are continuing to think about what can be done for park home owners.

Duncan Hames: The homes of millions of low-income households desperately need to be made highly energy efficient, so I welcome the Secretary of State’s announcement today about the private rented sector, but will he ensure that the scale and value of grants available are up to that challenge in the next Parliament?

Edward Davey: My hon. Friend is right to say that, in moving forward to take out the least energy efficient homes in the private rented sector and in other sectors,
	we need to ensure that there is a financial framework to support them. Landlords will be able to use either ECO, grants such as the green deal home improvement fund or green deal finance to assist them to meet the regulations.

Meg Munn: May I pay tribute to the former Member of Parliament for Sheffield, Heeley, Frank Hooley, who has died at the age of 91 and who campaigned for what was then described as alternative energy?
	In that vein, may I ask the Secretary of State what discussions he has had with Ministers in the Department for Business, Innovation and Skills about the Government’s providing greater investment to support companies that are developing mechanisms to improve energy efficiency such as micro and combined heat and power?

Edward Davey: I am sure all hon. Members will join the hon. Lady in paying tribute to the former Member who has died. I did not know him but I am sure he was a doughty campaigner for alternative energy.
	The hon. Lady asks what my Department can do with BIS to assist in the deployment of technologies such as CHP. I assure her that I work closely with my right hon. Friend the Secretary of State for Business, Innovation and Skills on those issues, particularly to ensure that energy-intensive industries have support with the high costs that they face.

Jonathan Reynolds: Earlier this week, the National Federation of Occupational Pensioners predicted that the death toll from this year’s winter cold weather could be 40,000 people, the highest for 15 years. With figures such as those, how can the Government defend not spending the majority of the funds that they raise for energy efficiency on tackling fuel poverty?

Edward Davey: Fuel poverty increased significantly under the previous Government and it has fallen, albeit not as much as I would like, under this Government. When we publish the fuel poverty strategy shortly, the hon. Gentleman will see not only that we have managed in this Parliament to focus scarce resources on the problem, with significant success, but that we plan, through the private rented sector regulations and other measures, to bear down on fuel poverty even further and faster.

Jonathan Reynolds: The Secretary of State is too complacent and I do not agree with his assessment at all. The fact is we have the means to tackle fuel poverty. What is lacking is the political will. His Government know that. Is it not a fact that the technical annexe to the Government’s own fuel poverty strategy admits not only that the Government will not eradicate fuel poverty by 2030 but that it will rise?

Edward Davey: Since we have not published the final fuel poverty strategy it is interesting that the hon. Gentleman makes those points.

Jonathan Reynolds: It is on the website.

Edward Davey: He is probably talking about the draft strategy. He needs to see the final one before he makes such points. The fuel poverty regulations that we have
	introduced are radical and have not received the attention they deserve. Under the regulations, by 2030 any person who is in fuel poverty must be in a house of at least EPC rating C. That is a major step forward and we have the policies, set out in the fuel poverty strategy, to deliver that.

Oil Prices (North Sea)

Michael Connarty: What assessment he has made of the effect of lower oil prices on oil and gas extraction from the North Sea.

Matthew Hancock: Oil companies around the world are reacting to the rapid fall in oil prices and prioritising activity. We are working to ensure that we deliver maximum economic extraction from the North sea. I will be travelling to Aberdeen later today to discuss that with the industry.

Michael Connarty: It does seem that others are doing things around the world, but this Government are doing very little. The Energy Minister did not reply to this; he is posted missing on it. He was also posted missing at the summit in Aberdeen. At that summit, the point was made that the two things that are required are investment tax write-offs, so that people continue to invest in future fields, which will stop if they do not continue to invest; and a reduction in the taxation on the fields, which the Government increased massively to 30%. If we bring the tax back down to 20% and put in tax investment, we might sustain this field—this week, Shell announced that it is closing the Brent field, the first field to bring oil into this country from the North sea.

Matthew Hancock: Work of a collaborative tone to support maximum extraction from the North sea might be more appropriate considering some of the inaccuracies in the question. Not only did we take measures in last year’s autumn statement to support oil companies to ensure the maximum extraction, but we are looking at what further we can do in the Budget. The Secretary of State was in Aberdeen last month, and I will be in Aberdeen later today. We are taking this action to support the maximum possible extraction in terms of economic ability from the North sea.

Anne Begg: I am glad the Minister will finally make his way to Aberdeen, and while he is there I hope he will have discussions with all aspects of the industry and the trade unions. I have two asks of him when he is in Aberdeen. One is to talk about what will happen to replace the jobs that have been lost—in one week, 600 jobs, and over the piece it is now into the thousands in one geographic area, if we can imagine that. I wonder what the reaction would be elsewhere. The second ask is to make sure that investment continues, even though we know the industry has to squeeze costs out of the supply chain, so that when the price of oil does pick up the industry has not been decimated.

Matthew Hancock: These are good questions and they were being discussed even before the oil price fell. It is very important that we come to the best possible
	answer, but I think the hon. Lady and I would agree that it is far better that we sustain a strong industry through these challenges in Aberdeen—which we can do because we have a whole-of-the-UK balance sheet off which we can take decisions to support Aberdeen.

Community Energy Generation

Kerry McCarthy: What steps he is taking to encourage community energy generation.

Amber Rudd: This Government are proud of launching the UK’s first community energy strategy, which is increasing the proportion of home-grown, low-carbon generation across the country. We have committed £25 million to rural and urban community energy funds to help kick-start generation projects, and communities can access the feed-in tariff scheme, which provides a long-term guaranteed income stream for communities.

Kerry McCarthy: Bristol, as European green capital this year, is certainly very keen to push forward on community energy, but I am told that progress has stalled as a result of Treasury changes to tax incentives and Financial Conduct Authority changes to the rules for establishing energy co-ops. Community Energy England and Co-operatives UK say these changes threaten the very viability of the community co-operative model. What is the Minister doing to respond to these concerns?

Amber Rudd: I congratulate the hon. Lady on Bristol’s nomination for European green capital, and it was a pleasure to visit the city with her and see some evidence of the green initiatives. I am aware of the problem she raises and I will follow that carefully and try to ensure it does not create any further blockage, because community energy is essential to our development of a proper renewables strategy in the UK.

David Heath: Will the Minister look carefully at the application of community feed-in tariffs to small-scale hydro? I recently wrote to the Secretary of State on behalf of villagers in West Lydford, who have made a heroic effort to repair a weir in Lydford. They formed a company to do so, and now find themselves in difficulties because of the rules.

Amber Rudd: I am aware of that issue and we will cover it in the community energy strategy update. I will ensure that the hon. Gentleman is kept informed of that so it addresses the particular problem he has raised.

Energy Bills

Philip Hollobone: What steps he is taking to ensure that energy bills for domestic consumers and business users reflect falling wholesale energy prices.

Edward Davey: My hon. Friend raises a vital issue and we have indeed been pressing the larger energy firms on this for some time. The good news is that energy prices have not only been frozen over the last
	year, but they are now being cut. Moreover, there is now a plethora of lower priced deals out there, especially from the independents, thanks to our policy of promoting competition, encouraging switching, and piling the pressure on the big six with an in-depth investigation of the energy market by the Competition and Markets Authority. I assure my hon. Friend we will continue to fight for the consumer every day.

Philip Hollobone: Recent Which? research shows that energy bills are the main financial worry of two thirds of households, and that while there has been a welcome reduction of about 5% in domestic tariffs this could have been as much as 10% had they mirrored the fall in wholesale costs. What more can the Government do to make sure the big energy companies are more responsive to falls in wholesale prices?

Edward Davey: Some energy suppliers have reduced their prices by 10%, and OVO Energy recently cut its prices by more than 10%. It is a complicated analysis and, working with the Treasury, we have looked at it in some detail. Wholesale gas costs represent about a quarter of the average bill; other costs are also changing and not all of them are going down. This is complicated, but it is right that the independent competition authorities look at this—they are specifically addressing this issue—because if there is any malpractice in the energy markets they will be able to expose it and have the teeth to tackle it.

Topical Questions

Kerry McCarthy: If he will make a statement on his departmental responsibilities.

Edward Davey: Since our last Department of Energy and Climate Change orals, we have seen significant progress for consumers on switching, energy prices and energy- efficiency. Energy firms have responded to my challenge and halved the time it takes to switch, from five weeks last year to 17 days now. That is helping people to switch to get big savings on their energy bills, as the extra competition we have backed is now seeing bills being not just frozen, but cut. Figures to the end of November show that the energy companies obligation and the green deal have delivered new boilers, windows and insulation to more than 1 million homes, four months ahead of our March 2015 target. In introducing to the House today tough new regulations to require landlords to ensure that their properties meet minimum energy-efficiency standards, we aim over the next three years to help about 1 million private sector tenants enjoy lower energy bills and warmer homes.

Kerry McCarthy: The global calculator published by the Department last week found that reducing our meat consumption is essential if we are to reduce our contribution towards greenhouse gases. Everyone from the United Nations downwards has for many years been talking about the contribution of the livestock sector to global emissions. His Department has always ignored this issue, so I urge him now to take action and to tell us what he is doing to encourage people to reduce their consumption.

Edward Davey: I think that is a little harsh. My Department published the calculator, so far from ignoring this, we are putting into the public domain not just a UK 2050 calculator but, having helped 20 other countries with their calculators, now a global calculator. It shows that people’s lifestyles—not just their meat-eating habits, but their transport and so on—all have an impact on climate change. The calculator enables people to look at the types of choices we may need to make in the future.

Philip Hollobone: What percentage of the domestic energy market was captured by the big six energy companies in 2010, and what is the percentage now?

Edward Davey: In 2010, the big six, created under the previous Government, had a share of the retail market of more than 99%. As a result of the competition we have encouraged, there has been a big increase in the number of independent competitors, whose market share has increased from less than 1% to more than 10.5%, and is rising fast.

Tom Greatrex: On 13 January, when answering an urgent question in this House on decommissioning at Sellafield, the Secretary of State said on three occasions that he would engage with the 10,000 people working at that complex site. What discussions have he and his officials had with those workers?

Edward Davey: We are engaging with those workers through the Nuclear Decommissioning Authority and through Sellafield Ltd, and we stand ready to assist in the discussions to make sure they understand the implications of the changes to their livelihoods. As I said in response to the hon. Gentleman’s urgent question, we are talking about good news for workers at Sellafield, and indeed it was welcomed by the MP representing that constituency.

Tom Greatrex: If it is such good news for the workers at Sellafield, I would expect the Secretary of State to be engaging with those 10,000 highly-skilled workers, who are very concerned about what the impact will be on their jobs and their livelihoods. I can tell him that there has been just one local meeting with those workers in the past few weeks, and very many of their questions were not answered. He has had communication from their representatives. Will he now undertake to fulfil the promise he gave this House just three weeks ago to engage properly with those people, at a time of severe anxiety for them?

Edward Davey: I absolutely will answer the questions put to me by the workers and their representatives, and I will ensure that the NDA and Sellafield Ltd make sure that they answer those questions, too. That is only right.

Tim Yeo: Does my right hon. Friend agree that maintaining high levels of generating capacity to meet peak demand, which may be for very short periods, imposes a cost on all consumers? Will he therefore undertake to look carefully at the capacity market mechanism next year to see whether a greater contribution can be made by demand-side response—the
	system under which consumers are incentivised to reduce their consumption at short notice during periods of peak demand?

Matthew Hancock: Demand-side response currently accounts for around 1.8 GW of balancing services, and we expect it to rise to around 2.5 GW. I have met the demand-side response industry a couple of times, and we will ensure that we take into account its concerns as we review the operation of the capacity market, which was incredibly successful this December.

Jim Cunningham: The Children’s Society estimates that in Coventry South 3,200 children are living in families trapped in energy debt. It has been calling on the Government to increase support for those families by changing the Department of Energy and Climate Change strategy and policy statement to include families with children as a vulnerable group. That will ensure that Ofgem and energy companies do their part to give families the support they need when they fall behind with their energy bills. Will the Minister give that some consideration?

Edward Davey: That is a very significant issue. When we were working on the fuel poverty strategy, using the analysis of Professor John Hills—the new method of looking at fuel poverty—we found that it uncovered a number of things that were not so obvious in the old method, such as people in off-gas grid homes being among the most fuel poor, and far more families being in fuel poverty as a proportion of the overall total. That is why the warm home discount is so important; it targets money on not just pensioners but low-income families. The fuel poverty strategy will now address that matter, too.

Peter Lilley: Earlier, the Under-Secretary of State said that, by 2020, we will see the availability of more advanced lower-cost solar panel technology, which will not require subsidy. Why not wait until 2020, rather than encouraging people to install high-cost, immature versions of that technology that will require us to commit to paying out subsidies right through to 2030?

Edward Davey: We have been cutting solar subsidies throughout this Parliament—indeed we have come under great attack for so doing, including from the Opposition. We are consulting on closing the renewables obligation system to the solar industry, and again that has led to a lot of criticism. However, I do not apologise for taking those measures, because it is important that we get best value for money for the taxpayer while encouraging the very important solar industry.

Diana Johnson: Siemens is to start the production of offshore wind turbines in Hull, potentially bringing in thousands of news jobs to the city. Is the Secretary of State aware that the UK Independence party opposes that investment and those jobs coming to Hull, and that the Greens are calling for a boycott of Siemens locally as well?

Edward Davey: I am glad that this is one issue on which the hon. Lady and I can agree. I recently went to Hull to see the latest development in the Siemens plan. The plan is very exciting and is crucial for Hull. It has been welcomed by business, education and the council in Hull. I agree it is astonishing that, locally, UKIP and the Green party are opposing the development. It is quite bizarre.

Sarah Newton: I very much welcome the Under-Secretary of State’s very positive response to my campaign with the Children’s Society to extend the warm home discount. Will she go a step further and seriously consider the auto payment of the warm home discount to these vulnerable families, in addition to the auto payment to pensioners?

Amber Rudd: I thank my hon. Friend for her question. We are all aware of the hard work she has done to support vulnerable people and to make such an extension happen. We are pleased that the warm home discount now extends to a broader group, which includes families with children, particularly those with children under five or disabled children. Data sharing is an important part of being able to find out how to deliver to the right people. We will of course keep those opportunities under review.

Caroline Lucas: Does the Secretary of State share the widespread disgust at Ofgem’s recent advice on paying energy bills, which included suggesting that families in fuel poverty should make packed lunches for their kids and cancel gym memberships? Instead of that insulting response, does he agree that the Government should consider changing rules, so that Ofgem advises on energy efficiency and not on packed lunches?

Edward Davey: I have not seen that advice. It is important that Ofgem focuses on trying to give the best possible advice that will help people who are struggling with energy bills. Government advice certainly includes practical suggestions on how to get the financial help that is available and to cut bills.

David Nuttall: Shale gas has the potential to reduce energy bills and increase the security of supply. Will my right hon. Friend set out what steps his Department is taking to allay public concerns about fracking?

Matthew Hancock: I am delighted that this question has come up although I am a bit surprised that it took until 10.29 to do so. It is also a bit of a surprise that the shadow Secretary of State is not attending DECC questions; I understand that she is campaigning in a Labour marginal seat. It is absolutely imperative and a duty on the Government to allow exploration for shale gas, which has the potential to be a significant resource, but to do so carefully and cautiously, and that is exactly what we are doing.

Kelvin Hopkins: What is the Government’s current position on constructing a Severn barrage lagoon to generate a substantial proportion of the nation’s electricity? If the Government are serious about their green ambitions, should they not be forging ahead with this project now?

Edward Davey: The hon. Gentleman may be muddling up the barrage and the lagoon. We have said that we will look at any environmentally sensitive and affordable proposal for the Severn barrage, if the private sector wants to propose one. To date, that has not happened, although he may well have missed the fact that my right hon. Friend the Chancellor of the Exchequer made it clear in the autumn statement that we are looking seriously at tidal lagoons. I recently published a consultation on how we would go about agreeing a contract for difference for a tidal lagoon.

Duncan Hames: I think that my right hon. Friend is persuaded that new housing is an infrastructure priority for the UK, so will he argue for newly energy efficient housing to be accorded that status also?

Edward Davey: I strongly believe that energy efficiency, related not just to housing but to other areas, should be a key infrastructure priority.

Jim McGovern: Like every other Member here, I am deeply disappointed to hear about further job losses in the North sea oil and gas industry. The National Union of Rail, Maritime and Transport Workers has said that, for every offshore job lost, three jobs onshore are lost. Does the Secretary of State agree that the best way to address this is to work together as a United Kingdom?

Matthew Hancock: I entirely concur with the hon. Gentleman’s words, and I look forward working the Opposition Front Benchers and Labour Back Benchers and, indeed, with the Labour leadership in Scotland, to try to do everything we can to ensure that we have a strong and healthy offshore industry, because the jobs are not only offshore but throughout the whole United Kingdom.

Alex Cunningham: It is becoming increasingly clear that the UK Government have failed to agree the European structural and investment fund’s operational programme with the European Commission. What is happening? What is the Secretary of State doing to ensure that the skills funding needed to achieve energy efficiency objectives is guaranteed until an agreement is reached?

Matthew Hancock: It is important that we get the details right and the programme will be forthcoming, but it is vital that we have the skills that come alongside energy development. We put a huge effort into getting that right, and I am sure that the hon. Gentleman will welcome the details when they are published.

Business of the House

Angela Eagle: Will the Leader of the House give us the business for next week?

William Hague: The business for next week will be:
	Monday 9 February—Motions relating to the draft Social Security Benefits Up-Rating Order 2015 and the draft Guaranteed Minimum Pensions Increase Order 2015, followed by motions relating to the draft Mesothelioma Lump Sum Payment Conditions and Amounts) (Amendment) Regulations 2015 and the draft Pneumoconiosis etc. (Workers’ Compensation) (Payment Of Claims) (Amendment) Regulations 2015.
	Tuesday 10 February—Motions relating to the police grant and local government finance reports, followed by motion to approve a money resolution relating to the Counter-Terrorism and Security Bill, followed by consideration of Lords Amendments to the Counter-Terrorism and Security Bill.
	Wednesday 11 February—Opposition day (17th allotted day). There will be a debate entitled “Labour’s job guarantee”, followed by a debate on tax avoidance. Both debates will arise on an Opposition motion, followed by, if necessary, consideration of Lords amendments.
	Thursday 12 February—Debate on a motion relating to pubs and planning legislation, followed by general debate on the destruction and looting of historic sites in Syria and Iraq, followed by general debate on the mental health and well-being of Londoners. The subjects for these debates were determined by the Backbench Business Committee.
	Friday 13 February—The House will not be sitting.
	The provisional business for the week commencing 23 February will include:
	Monday 23 February—Remaining stages of the Serious Crime Bill [Lords].
	I should also like to inform the House that the business in Westminster Hall for 12 February will be:
	Thursday 12 February—General debate on effect of national infrastructure projects on local redevelopment.

Angela Eagle: I thank the Leader of the House for announcing next week’s business. I welcome the publication today of the House of Commons Commission Bill, which will implement the recommendations of the Governance Committee’s report. Will he confirm that it is his intention to ensure that this legislation is on the statute book prior to Dissolution on 30 March? If that is his intention, may I assure him of our co-operation and support?
	Yesterday we had two vital statements on the inquiry into child sexual abuse and Rotherham, and as a result our Opposition day debates were severely curtailed. Given that the Leader of the House has to make such a superhuman effort to fill the Government’s paltry programme of business every week, will he grant Her Majesty’s Opposition a further half day to make up for it?
	I am sure we all enjoyed the first episode of Michael Cockerell’s documentary “Inside the Commons” on Tuesday. I think all right hon. and hon. Members will agree that it was a beautifully shot, illuminating depiction of life in this place, and I look forward to the remaining episodes with only a little trepidation. I must say that after a mere 23 years in this place, I had not realised until I watched the documentary that until very recently Members were entitled to free snuff. I feel that I have missed out. I was especially struck by the Prime Minister’s description of this place as half church, half museum and half school. All I can say is that this place certainly does not look like any school I ever went to, and Eton should clearly get a better maths teacher.
	This week marks the start of lesbian, gay, bisexual and transgender history month when we celebrate progress on LGBT rights while recognising that we must do more to banish bigotry and discrimination. This week my hon. Friend the Member for Stoke-on-Trent Central (Tristram Hunt), the shadow Education Secretary, launched Labour’s comprehensive plan to tackle the baleful legacy of section 28 and end the scourge of homophobic bullying in our schools. Will the Leader of the House arrange a debate on how we can make LGBT rights a reality in this country and around the world?
	On Tuesday we will debate motions relating to the police grant and local government finance reports, and nothing could better illustrate the huge gap between this Prime Minister’s rhetoric and his record. Before the election he said that a Conservative Government would not cut any front-line services. Five years later we have almost 17,000 fewer front-line police officers, 9,000 fewer front-line NHS staff, and the 10 most deprived areas in the UK have suffered cuts 16 times greater than the leafy Tory shires. Before he was elected, the Prime Minister promised that education would be a big priority, but his previous Education Secretary managed to alienate everyone he came across. Even the Conservative-led Education Committee has concluded that there is no evidence that the Government’s ideological dash to create academies has made any difference to standards whatsoever. In my own constituency on the Wirral, 19 of the 21 secondary schools are facing serious financial strain, and this week we learned that the Tories’ solution is to slash the schools budget by 10% if they win the election, disguised by the Prime Minister in a speech last week as “flat cash”.
	The Prime Minister has broken so many promises that he has created a whole new medical condition—Camnesia. Cutting the deficit, not the NHS? Camnesia. The greenest Government ever? Camnesia. Balancing the books by the end of this Parliament? Camnesia. His condition is now so bad that he is officially even worse than the Liberal Democrats at keeping his promises.
	The Prime Minister laughably asserted yesterday that this election is a choice between competence and chaos, but he failed to notice the chaos around him. We have a Tory Chief Whip who still pines after his old job and a Lib Dem Chief Whip so exercised by this Government’s legislative agenda that he is reportedly falling asleep in Cabinet. We have a Work and Pensions Secretary whose flagship benefit reform is so behind schedule that, at the current rate, it will take 1,571 years to complete. We have a universities Minister who is so out of touch that he is telling students not to worry about debt because three years of tuition will cost them only 13,846 cups of
	posh coffee. Using that coffee currency, I have estimated that the Government have missed their borrowing target by 64 billion salted-caramel lattes.

William Hague: As ever, we have enjoyed the hon. Lady’s questions. In fact, I was having a look, as so many people are, at the betting odds for who will be the next leader of the Labour party. I must congratulate her, because it turns out that she has now entered the list at Ladbrokes at 100:1. Admittedly, that is only a start—the same level as Ken Livingstone and Lord Mandelson—but I might fancy a flutter on the prospect, because we know that we can laugh with her, whereas there are one or two of her colleagues whom we can only laugh at. I wish her well in moving up the odds.
	The hon. Lady asked about the House of Commons Commission Bill, which has indeed been published today. It is certainly my intention to have it on the statute book by Dissolution. It has a great deal of cross-party support, so I hope that we can arrange Second Reading and other stages soon after the February recess.
	There are several more Opposition days to come in this Parliament. We make a genuine effort to avoid having many statements on Opposition days. I think the House understands that yesterday’s statements from the Home Secretary and the Communities and Local Government Secretary were highly important, and indeed that it was urgent that they came to the House as soon as the report on Rotherham was available. Occasionally that happens on Opposition days, and it is unavoidable, but that does not mean we can create additional Opposition days; it means we try to avoid it on other occasions.
	Like the hon. Lady, I enjoyed the BBC’s documentary “Inside the Commons”. My comprehensive school did not look anything like this place either, and I would have known that three halves add up to more than one. On the other hand, forgetting that three halves add up to more than one is a bit better than forgetting the entire Budget deficit, which was the performance of the Leader of the Opposition.
	I absolutely agree with the hon. Lady about the importance of LGBT rights. Indeed, the Education Secretary has just announced a £2 million fund to help tackle homophobic bullying in schools. There is a good case for a debate on these issues, although it is most likely to be successful as a Back-Bench business debate. I would certainly support such a debate taking place.
	The hon. Lady asked about public services. It is a common mistake for the Opposition to think of public services in terms of inputs, rather than outputs and what is actually achieved. For instance, over nearly five years we have seen crime fall by a fifth, we have seen a huge increase in the number of children in schools rated good or outstanding, and we have seen satisfaction with the health service increase—except in Wales, where it has gone down. That is what matters to people: the actual performance and achievements of public services.
	I hope that in the debates that the Opposition have called for next week we will be able to look at the recent economic good news, because just in the past week we have seen construction output growth rebound, manufacturing growth accelerate, and consumer confidence make a large jump, and the car sales figures announced
	this morning are up 7% on the year. The real jobs guarantee—they have a debate next week on a jobs guarantee—is that sort of success, as is the growth of 1.75 million jobs in this country over the past four and a half years. At least in that debate the Opposition will be able to tell us what advice they have received on jobs from Bill Somebody and their business supporters, or Fred Somebody, or Joe Somebody—or just somebody. It is not an age thing on the part of the shadow Chancellor that he could not remember the names of any business supporters; it is a being totally out of touch with job and business creation thing.
	Even by Labour Members’ own chaotic standards, they have had a special week, with university vice-chancellors attacking their fees policy, saying that it would
	“damage the economy…and set back work on widening access”;
	with business people who were Ministers in the previous Government attacking their attitude to business and wealth creation; and with their own peer, Lord Glasman, saying they need bold leadership but have got the Leader of the Opposition. Nothing could better demonstrate the real choice between competence on this side of the House and chaos on the other.

Jacob Rees-Mogg: I apologise for boring the Leader of the House on this subject, but I must bring him back to the debate requested by the European Scrutiny Committee one year and two weeks ago on the free movement of EU citizens. In answering my previous questions, my right hon. Friend has been immeasurably emollient and tactful, but nothing happens. It is a grave discourtesy to this House that the Government do not follow the proper scrutiny procedures. It is about time we had this debate, and it is a considerable disappointment that it was not in his announcement.

William Hague: My hon. Friend is never boring. [Hon. Members: “Oh yes he is!”] Well, only occasionally then, in the view of the House. In my view, he is never boring. I always try to be emollient and tactful. Indeed, I am going to the European Scrutiny Committee to discuss some of these things next week. I certainly intend that some of the debates that the European Scrutiny Committee is waiting for will take place on the Floor of the House or in Committee in the coming weeks.

Jack Straw: May I first express my very great appreciation to the right hon. Gentleman and, indeed, to his private office for being so speedy and co-operative in ensuring that the House of Commons Commission Bill gets on to the statute book? I know that he is also committed to ensuring that changes in Standing Orders are brought forward.
	May I ask the right hon. Gentleman about something slightly different, however, which is plans for handling England or England and Wales-only legislation in this place? I personally accept that that is a tricky and difficult issue, and one on which I hope, please God, we get a consensus. He may recall that in the House on 16 December I asked him to publish
	“a list of legislation that…would not have gone through this House if it had been endorsed only by English or by English and Welsh MPs”,
	and he said:
	“I will certainly have such an analysis published.”—[Official Report, 16 December 2014; Vol. 589, c. 1271.]
	Can he say when this is going to happen?

William Hague: I am grateful for the right hon. Gentleman’s remarks about the House of Commons Commission Bill. We have certainly done everything we can speedily to implement his Committee’s excellent report, and we will continue to do so.
	I will be publishing that analysis. He wrote to me about this yesterday. The analysis is almost complete. There are several different ways of cutting the numbers in making such an analysis, so it has been a bit of a task for the officials doing it, but I will ensure that it is placed in the Library of the House pretty soon.

George Young: Further to that question, on Tuesday my right hon. Friend announced that he and the Prime Minister had selected option 3 as the best one on English devolution—a decision with which I wholly agree. He went on to say that this option would be
	“put forward to Parliament and the country”.
	Can he confirm that it will take place in that order?

William Hague: I can confirm, as ever, my earnest hope that it takes place in that order. There is a very good case for this to be debated in Parliament before the general election. As I have indicated before to my right hon. Friend, we are having discussions within the Government about how to structure such a debate. Those discussions have not yet been concluded, but they are going on vigorously.

Barry Sheerman: May I ask the Leader of the House for an early debate on election spending by political parties? Many people in this country do not know that, against the Electoral Commission’s advice, the limits on spending have gone very high indeed. We have had news this morning that the Conservative party is spending £10,000 a month on Facebook alone. This used to be a country, unlike the United States, where money did not count that much, although even at the last election, under the old rules, the Conservatives spent twice as much as the Labour party. Now we know that about £40,000 can be spent in every constituency, and massive sums are being put into social media and elsewhere. This is not the sort of democracy that most people in this country want. May we have a debate on that?

William Hague: There have been many debates in the House on such matters over the years. Ministerial responsibility for them rests in the Cabinet Office and there will be Cabinet Office questions on Wednesday, so the hon. Gentleman will have the opportunity to pursue the matter on the Floor of the House. The increase in spending limits that has been introduced for the coming election is the first increase in a long time. It is necessary in a thriving, robust democracy for the voters to be informed. There should be no criticism of the discussion of elections on social media, because that is how much of the world now conducts its discussions. Other parties will have to catch up.

Anne McIntosh: The whole country has been shocked by the animal cruelty at the Bowood Yorkshire Lamb abattoir at Busby Stoop, which was the site of hangings at the time of Dick Turpin and so is known for historic reasons. An
	investigation is rightly ongoing, but will my right hon. Friend permit the earliest possible debate on animal welfare provisions, particularly in slaughterhouses, and on the European provisions for the labelling of meat produced for halal purposes? It is essential that farmers are assured that the high levels of animal welfare that they respect are not let down at the last moment at the point of slaughter.

William Hague: The whole country takes this matter very seriously. This country rightly has a high reputation for animal welfare, and that must be preserved. Investigations into the matter are taking place, as my hon. Friend says, and those are important. The Crown Prosecution Service is considering the evidence for a possible prosecution. On labelling, we support the EU study that is looking at consumer opinions on methods of slaughter labelling. That study has been delayed, apparently, but it is now expected in the next couple of months. We will be able to review the options at that point and I am sure that the House will want to debate them.

Kevin Barron: I am delighted to see that action 20 of the Government’s anti-corruption plan states:
	“House of Commons to approve the proposed amendments to the Guide to the Rules relating to the conduct of Members”,
	with a deadline of March 2015. The Committee on Standards is very happy to support the Leader of the House in implementing that Government policy. When will the debate take place?

William Hague: I am very grateful for the right hon. Gentleman’s support. I absolutely hope that the debate will take place. He and I have discussed it a number of times. There are a number of outstanding Committee reports to address in the remaining weeks of this Parliament. My hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) talked about a European Scrutiny Committee report, there are important reports from the Procedure Committee and there is this important report from the Standards Committee. I will do my best to accommodate these things in the coming weeks, with the right hon. Gentleman’s support.

Christopher Chope: When will my right hon. Friend publish the draft changes to Standing Orders that will be necessary to implement English votes on English issues?

William Hague: That is a party matter, rather than a Government matter, since there are different policies among the coalition parties. However, it is important to show the detail, so I intend later this month to set out how the proposal that I made earlier this week can be implemented in Standing Orders.

Caroline Lucas: City college Brighton and Hove is struggling in the face of cuts to funding and rising costs. The staff, students and unions are all rightly concerned. May we have an urgent debate on funding solutions for the further education sector that are progressive and fair, and can that include looking again at a remedy for the historical unfairness in funding for 16 to 19-year-olds, in that they have to pay VAT in a way that their colleagues do not?

William Hague: There is always a good case for debating further education and other educational issues in this country, but I do not know that there will be time to do so in the remaining six weeks before the Dissolution of Parliament. That will be a common answer for me to give to Members who raise many important issues. After today, there are only 26 sitting days left for the House of Commons before the general election, so we have to bear that in mind. However, I think that the hon. Lady could make a good case to the Backbench Business Committee for a debate on that subject.

David Heath: The Leader of the House represents a north Yorkshire constituency, so he will be familiar with the F40 campaign for fair funding for those chronically underfunded education authorities, in which I was first involved when I was chair of education in Somerset back in 1996. To their credit, the Government have recognised the injustice and have done something to mitigate the effects next year, but what we need is a basic change of formula. Will the Secretary of State for Education make a statement to the House on that issue, or if not, may we have a debate?

William Hague: My hon. Friend is right: as a north Yorkshire Member of Parliament who represents a very rural constituency, I am conscious of that campaign. He is also right to give credit to the Government for what we have done. In the coming financial year, we will distribute an additional £390 million to 69 of the least fairly funded education authorities. That is the biggest step towards fairer funding for at least a decade and, as he will know, we have committed to moving to a fully fair and transparent funding system by introducing a national funding formula in the next Parliament. For the reasons I gave earlier, I cannot offer additional debates, but this is a very important commitment for the future.

Stephen McCabe: Four days before Christmas, my 12-year-old constituent, Phebe Hilliage, was knocked down on a pedestrian crossing by a hit-and-run driver. Her foot was shattered and she may never walk properly again. The driver has not been caught. May we have a debate on what more can be done to tackle such offences? There are thousands of these incidents every year and I would like to know what more can be done, and which police forces have the best records, and why. Do not victims such as Phebe deserve justice and should it not be a much higher policing priority to apprehend these callous offenders and bring them to book?

William Hague: The hon. Gentleman raises an issue about which both sides of the House will have strong feelings. Victims of such crimes, like Phebe, deserve justice. I know that much ministerial attention has been given to the issue in earlier years, but I do not deny that there is a good case for Parliament to examine the matter. We do not have much time for additional debates, but the hon. Gentleman will be able to raise it with Ministers at questions and with the police and crime commissioner in his area. I will also convey his remarks to Ministers in the Ministry of Justice and the Home Office.

Andrew Turner: Many people on the Isle of Wight are dismayed that sailing has been axed from the 2020 Paralympic games in
	Tokyo. My young constituent, Natasha Lambert, who suffers from cerebral palsy, proves that disabled people can now compete on more than equal terms—she is inspirational. Will the Leader of the House join me in praising Natasha’s considerable achievements and find time for a debate on how that decision can be challenged?

William Hague: One of the greatest things about our hosting of the Olympic games was the immense success of the Paralympic games. We should be grateful to my hon. Friend for bringing the inspirational achievements of Natasha Lambert to the attention of the House this morning. The decision on what sports are in the programme for each Paralympic games is a matter for the International Paralympic Committee. National governing bodies can make representations, but it is not something for us in Parliament or Government to decide. I will certainly share Natasha’s achievements and her concerns with my colleagues in the Department for Culture, Media and Sport.

Jeremy Corbyn: The Leader of the House will be aware that the five declared nuclear weapon states are meeting in London to discuss the preparations for the non-proliferation treaty review conference in New York in April and May. Will there be a statement from the Government on the outcome of those meetings and on their position ahead of the conference? Specifically, will the Government give us some good news or otherwise on the preparations for a middle east weapons of mass destruction-free zone conference, which—as he will appreciate from his time as Foreign Secretary—is crucial to try to bring about a long-term peace and prevent a nuclear arms race in the area?

William Hague: I very much appreciate that, and how assiduously and regularly the hon. Gentleman pursues these issues. Preparations for the non-proliferation treaty review conference are extremely important. The United Kingdom has always made a major contribution, including at the last conference in 2010. I know my colleagues in the Foreign and Commonwealth Office will want to inform the House about how they are approaching that. I will pass on the hon. Gentleman’s request to them.

Karl McCartney: May I say what a pleasure it was hearing you open the Magna Carta exhibition in the other place this morning, Mr Speaker?
	The Leader of the House will know that Magna Carta enshrines the principle that no man is above the law. How is it then that the chairman of Independent Parliamentary Standards Authority, Sir Ian Kennedy, who has lied about Members to the media and still refuses to apologise, was appointed with no debate in this House for a further two years using the deferred Division device? Does my right hon. Friend not think it time that we should have a debate on the failings and rising costs of IPSA and the back channels to the current and former Chief Whips?

William Hague: It is up to the House whether it wishes to debate those matters. My hon. Friend is well familiar with the means of doing so; he has succeeded in raising his concerns about IPSA on the Floor of the House today. That can, of course, also be done through Backbench Business Committee or Adjournment debates. Having
	seen a lot of IPSA’s work since I became Leader of the House, I think Sir Ian Kennedy will be able to make a good defence of its work, but hon. Members have concerns and they can be raised in the way I have described.

Andrew Miller: In responding to my hon. Friend the Member for Wallasey (Ms Eagle), the Leader of the House referred to inputs as well as outputs in the public sector. With that in mind, may I bring to his attention a recent contract relating to sexual health in Cheshire, where the winning bid appears to have been allocated not on the basis of value for money or the right skill set, but a political fix? This is a very serious issue about public integrity. May we have a debate about such contracts? Will the Leader of the House ask both the Secretary of State for Health and the Secretary of State for Communities and Local Government to investigate this very serious matter?

William Hague: The hon. Gentleman would not expect me to be familiar with the particular matter he raises, but before any consideration of a debate it would be best for him to write with the details to the Secretaries of State for Health and for Communities and Local Government. I will certainly alert them to what he has said today, but he will need to give them the details of what he is alleging for them to be able to look into it.

Bob Stewart: On Tuesday 27 January, Ian Thomson, a committee specialist on the House of Commons Defence Committee, was severely hurt while accompanying my hon. Friend the Member for Colchester (Sir Bob Russell) and me on a visit to the Falkland Islands. He broke his elbow very badly—it was incredibly painful—when he fell out of a Land Rover in the rain on the airstrip. He immediately went through the casualty evacuation procedure. A Sea King flew him to Stanley hospital, which said the injury was too bad for them to deal with—there are only 3,000 people on the island—and that he required an orthopaedic surgeon. The RAF flew him back to Mount Pleasant airfield from where he was immediately flown—first in a 1564 flight Sea King helicopter and then in the back of a 1312 flight C-130 Hercules aircraft—across the south Atlantic to a hospital in Montevideo in Uruguay. Throughout, he was accompanied by squadron leader Jen Russell, the unit medical officer. May I ask my right hon. Friend to join me in thanking our service personnel in the south Atlantic for they way they have dealt with one of our own? They would have used exactly the same procedure for one of their own.

William Hague: My hon. Friend well demonstrates the professionalism and dedication of all our armed forces, consulate and embassy staff. We should express our thanks to the British embassy in Montevideo for visiting Ian Thomson daily and looking after him so well. We are very grateful for such professionalism so far away. I understand that he is on the mend after three operations, but is likely to have to remain in the Montevideo hospital for the next seven to 10 days. It is a reminder of the hard work of our Clerks and the professionalism of our armed forces.

Andrew Gwynne: I fear that the Leader of the House was a little unfair to the Prime Minister earlier, in that the many leaking roofs in corridors and rooms in Parliament are reminiscent of my comprehensive school in the 1980s.
	Is it time for a debate on modernising the procedures of this place, particularly in relation to Committees? Yesterday, I was in the Committee of the National Health Service (Amended Duties and Powers) Bill, introduced by my hon. Friend the Member for Eltham (Clive Efford). The full two and a half hours were filled with bogus points of order and a spurious debate about whether we should meet on Tuesdays or Wednesdays at 9.25 am or 10 am, right up to the point of interruption. Is it not time we got rid of these archaic procedures so that people out there can start to see MPs debating the issues that matter? As the Leader of the House knows, the NHS is people’s No. 1 concern.

William Hague: I remember, in my A-level politics class at Wath comprehensive, studying next to a bucket catching drips from the ceiling. I did not think that 40 years later I would be standing in the House of Commons with buckets in the Central Lobby. It has seemed very familiar recently.
	I do not know the details of what happened in the Committee, but I am sure that the Chair acted perfectly correctly in taking whatever points of order were raised and ensuring that procedure was followed. On the modernisation of procedures, I referred earlier to outstanding reports from the Procedure Committee—[Interruption.] Its members are nodding vigorously at the idea of debating them, and I hope that many of them will be so debated in the coming weeks, so that those changes for which there is considerable demand in the House can be taken forward.

John Glen: Today, all four copies of the Magna Carta, including the best one, which is usually at Salisbury cathedral, are on display in the House of Lords. On this historic occasion, will my right hon. Friend reassure my constituents that the Government intend to honour the commitment in the Magna Carta to delaying justice to no one by overcoming the difficulties across Government and both parties of the coalition, and ensure that the House has a vote on English votes for English laws at the earliest opportunity?

William Hague: I thank and congratulate my hon. Friend on his question and pay tribute to Salisbury for long hosting one of the great copies of the Magna Carta.

John Glen: The best copy.

William Hague: The best copy, as he has explained, although I had better remain neutral on that point. As I said to my right hon. Friend the Member for North West Hampshire (Sir George Young), I very much believe that there should be a debate on English votes for English laws and that the changes we have set out should be implemented, come what may. I will do everything I can to bring about both those things.

David Anderson: Last autumn, NHS England halted the testing and licensing of the drug Translarna—a drug that could transform the lives of young boys with Duchenne muscular disease—to embark on a bureaucratic internal discussion on how it does business. Despite genuinely warm words from the Prime Minister and his attempts to move things on, we have been advised this week that the process will not change and that NHS England will continue with its
	public consultation and further discussions. While it is talking, young boys will stop walking. Can we have a statement from the Health Secretary about what exactly is happening, so that the House can express it views? Clearly, he does not seem able to intervene with NHS England, and as long as that does not happen, these young boys will see their lives destroyed.

William Hague: The Prime Minister has spoken about this before, in response, I think, to the hon. Gentleman, who regularly pursues this matter in the House. I think the best thing I can do to help is to inform the Health Secretary of his concerns about the time scale and ask him to respond directly. It is also possible for the hon. Gentleman to pursue debates through all the normal methods, in addition to his having raised it in the House today.

Philip Davies: The shadow Leader of the House should not get her hopes up too high because I am also 100:1 to be the next leader of the Conservative party. As the Deputy Prime Minister is also 100:1 to be the next leader of the Conservative party, I think 100:1 means we have absolutely no chance whatever.
	There is no greater admirer in this House of the Leader of the House than me, but his proposals for English votes for English laws are completely unacceptable and inadequate, largely due to the fact that they do not deliver English votes for English laws and still deliver Scottish votes for English laws. English MPs have no impact at all on legislation to do with Scotland and most people think that Scottish MPs should have no impact on legislation that applies only to England. Can we make sure that we have the debate on English votes for English laws and can he make sure that all the options are put for a vote in this House? He would then probably find out that most of the parliamentary party on the Conservative Benches actually believe in true English votes for English laws.

William Hague: I am impressed to discover that my hon. Friend is 100:1 to be next leader of the Conservative party, and I would not rule out voting for him myself, provided quite a lot of the other alternatives had been exhausted by that point. [Laughter.] I will not go into quite how many would have to be exhausted. On the question of a debate on English votes for English laws, I hope that I have already answered that question. On the question of what is the right policy, I think I might have a better idea than anyone of the views of Members of the Conservative party, having consulted them extensively. I am confident that the proposal I put forward enjoys their support. But of course in any debate my hon. Friend will, as always, be free to give his own views. Who could ever prevent him from doing so?

Diana Johnson: I understand that the Government have decided to extend Flood Re to cover the most expensive houses in the country but not to cover the new properties that are being bought under the Help to Buy scheme, many of which are on Kingswood estate in my constituency, one of the most successful parts of that scheme in the country. Could we have a debate on flood insurance, which is such an important issue to householders, and on whether there is now an extension of the Flood Re
	scheme to help the rich to buy, by allowing them to get flood insurance, whereas a poorer person will not be eligible?

William Hague: Flood insurance is a very important issue, as I know from when flooding has taken place in my constituency. It is of huge importance to people. I do not think there can be any serious suggestion that the policy on this is being decided on the basis of rich or poor. Nevertheless the hon. Lady is making a case for a debate on an important subject. I will reflect that to the Ministers responsible and I encourage her to pursue it through all the normal methods of achieving a debate on a general issue in this House, with which she is very familiar.

Peter Bone: If my hon. Friend the Member for Shipley (Philip Davies) says that, at 100:1, he has no chance of being the party leader, I, at 200:1, cannot even expect the support of the Leader of the House. Interestingly he is only 7:2 to be the next leader of the party.
	This may help my cause, Mr Speaker: I and my hon. Friends the Members for Shipley, for Christchurch (Mr Chope), for Bury North (Mr Nuttall) and for Kettering (Mr Hollobone) have been conducting a pilot scheme on behalf of the Prime Minister for the whole of this Parliament which, only this week, the Prime Minister announced he was in favour of. On Sky News he said that he wants more people to vote according to their conscience and not the party line. He wants more free votes. Could we have a statement from the Leader of the House next week on whether he has been able to transmit that information to those people who represent the forces of darkness?

William Hague: I did not know that they were taking bets at 200:1 but I wish my hon. Friend well on shortening those odds. As someone who has served for most of his parliamentary career on one Front Bench or another, I have always been in favour of MPs voting according to their conscience, provided there is some co-ordination of how they feel about their consciences before they come to do so. I have not noticed any great inability of my hon. Friend to vote with his own conscience at any point in this Parliament and I am sure that he will feel free to continue that record in the future.

Kevin Brennan: May we have a debate on trade with Bangladesh? I was fortunate enough last week to visit Bangladesh with the Wales Bangladesh chamber of commerce, led by my constituent Dilabor Hussain and accompanied by Trefor Jones and Llinos Lanini representing a local company in my constituency called Iviti, which develops and manufactures in Wales an innovative LED light bulb that stays on when the power is cut. Would not having such a debate give us an opportunity to emphasise the strong ties between the UK and Bangladesh, as well as opportunities to trade with this important growing economy?

William Hague: Yes, it would. I congratulate the hon. Gentleman on that little advertisement for something made in Wales. Our ties with Bangladesh are important. While the hon. Gentleman was over there in Bangladesh, I was speaking last week at the British Bangladeshi power and inspiration awards, saluting the many people of Bangladeshi origin who make an immense contribution
	to this country and our business success. This is something to celebrate. I hope the hon. Gentleman will push the case for a debate, but given all the constraints on our remaining time, he will have to do so through all the other normal channels.

David Nuttall: The United Kingdom is being forced by the EU’s Brussels bureaucrats to replace on our railways distance signs showing miles with ones showing kilometres. May we have a statement on what this will cost and on the potential risks to staff and passengers?

William Hague: I understand from the Department for Transport that this European traffic management system is meant to be a major improvement in safety on the railways. We already have one of the safest railways in Europe, and this is expected to make the network even safer. Where it is installed, it will apparently use the metric system, but when drivers operate in areas of the conventional system, their speedometers will automatically switch to imperial measurement. My hon. Friend will be relieved to hear that. In the UK, the drivers of trains and the signallers will not be required to convert units between imperial and metric. They will be able to concentrate on driving the train.

Barry Gardiner: Next month, the European Commission will publish its INDC for the contributions on emissions reductions towards the Paris conference of the parties in December. Unfortunately, INDC stands for intended nationally determined contributions. What progress has the Leader of the House made in ensuring that there will be parliamentary scrutiny and accountability of the European INDC? Given that it is supposed to be nationally determined, what element of the European INDC will be allocated to the UK, and how? How is Parliament going to address these issues at a national level as it should do in contributing towards the COP?

William Hague: We have just had Energy and Climate Change questions. I was not here for all the questions, so I do not know whether the hon. Gentleman or others raised this issue. In any case, as he says, there are further announcements to be made. I am sure my colleagues at the Department of Energy and Climate Change will want to keep the House informed one way or another. For all the reasons I have given about the constraints on our time in the remainder of the Parliament, I cannot make any commitment to the hon. Gentleman on how the House will consider this. He makes a good case, however, and I will make sure that those Ministers are conscious of what he says; I am sure they will want to keep us informed of this country’s commitments.

Philip Hollobone: I bring good news from Kettering. Since 2010, not only are there 43 more hospital doctors and 55 more nurses at Kettering general hospital, but the number of operations performed each year has increased by a massive 15% to 48,000. With a 24% increase in diagnostic tests, a one third increase in the number of people treated for cancer and a 71% increase in the number of MRI scans performed, may we have a debate on the Floor of the House about how increasingly world-class standards of health care are delivered to ever-larger numbers of people by hospitals such as Kettering general hospital?

William Hague: Once again, my hon. Friend brings the House good news from Kettering—and, as I said last week, I suspect that it may continue for some time, because he never fails to do so.
	During our next debate on the national health service, it will be important for Members to analyse the figures from Kettering and from other constituencies. In Kettering, there has indeed been an increase in the number of hospital doctors and nurses, and a large increase in the number of operations. Moreover, I note from the figures that I have here—because I was prepared for the good news from Kettering—that there has also been a huge increase in the number of diagnostic tests, and, at the same time, a tremendous decrease in the incidence of hospital infections. Indeed, the incidence of hospital infections throughout the country has virtually halved in the last four and a half years. That is exactly the sort of good news about the health service that people do not hear enough about.

Nicholas Dakin: I recently met representatives of a Scunthorpe firm, Clugston Logistics, who briefed me about the increasing difficulty of recruiting drivers of heavy goods vehicles. The Road Haulage Association estimates that there could be a shortfall of as many as 40,000 if action is not taken. May we have a statement about how the Government are trying to address that very real need by ensuring that we have more UK-resident trained HGV drivers in the future?

William Hague: That is a legitimate question. Those who travel around the country nowadays will see a great many advertisements for HGV drivers, which reflects the demand. Questions to the Secretary of State for Business, Innovation and Skills will take place next week, and will provide an ideal opportunity for the hon. Gentleman to raise the matter directly with the Minister who is responsible for that area of policy.

Daniel Kawczynski: I was pleased that my right hon. Friend mentioned the NHS in Wales in his response to the business question. Wrexham Maelor hospital, which is just across the border from us in Shropshire, is meeting only 64% of its A and E targets. As a result, more people are coming across the border, and from north Shropshire, to use my local hospital, the Royal Shrewsbury, thus putting pressure on it. The Health Secretary, to whom I spoke earlier in the week, is being given anecdotal evidence by other English Members of Parliament on our side of the border who are also feeling the strain. May we have a debate on the Floor of the House about the impact that Labour’s mismanagement of the NHS in Wales is having on hospitals on our side of the border?

William Hague: As I said earlier, it will be important for details of that kind to be discussed when we next debate the national health service. As we learnt last week, satisfaction with the NHS in England has risen from 60% to 65%, whereas—I speak from memory—satisfaction with the NHS in Wales has fallen from 53% to 51%. The performance of the health service, in the view of the people who use it, is clearly diverging. A and E targets were last met in Wales in March 2008, and that is a record that must be borne in mind when we hear complaints from Opposition Members.

Point of Order

David Davis: On a point of order, Mr Speaker. I wish to make a request of you, in the context of your responsibility for protecting the privileges of Members.
	Yesterday, the Interception of Communications Commissioner, Sir Anthony May, criticised the British police for intercepting journalistic communications in order to determine journalistic sources. As a direct result of that, No. 10 Downing street instructed the Home Office to change the arrangements so that in future the police would have to secure judicial approval before intercepting or collecting data on journalistic communications.
	A year ago, my hon. Friend the Member for Enfield North (Nick de Bois) asked the Cabinet Office whether the Wilson doctrine applied to information collection of that kind in respect of Members of Parliament. The same issue applies: just as journalists want to protect their sources, we need to protect our constituents—who may be complaining about the state—and whistleblowers. Given your responsibility for protecting our privileges, Mr Speaker, will you make inquiries of the Government to establish whether our communications are protected in this way, and whether, if they are not, they should be subject to judicial oversight?

Mr Speaker: The short answer—I am grateful to the right hon. Gentleman for that highly pertinent point of order—is that I shall make inquiries. Having made such inquiries, I will revert to the right hon. Gentleman, but I think, in all propriety, and suitably notified in advance, I will report to the House.

Backbench Business

GP Services

Derek Twigg: I beg to move,
	That this House notes the vital role played by local GP services in communities throughout the UK, with an estimated one million patients receiving care from a family doctor or nurse every day; believes that the UK’s tradition of excellent general practice provision is a central factor in the NHS being consistently ranked as one of the world’s best health services by the independent Commonwealth Fund; expresses concern, therefore, that the Royal College of General Practitioners (RCGP), through its Put patients first: Back general practice campaign, is warning that these services are under severe strain, with increasing concerns raised by constituents about access to their GP and 91 per cent of GPs saying general practice does not have sufficient resources to deliver high quality patient care; further notes that the share of NHS funding spent on general practice has fallen to an all-time low of 8.3 per cent, and that over 300,000 people across the UK have signed the campaign petition calling for this trend to be reversed; welcomes the emphasis placed in NHS England’s Five Year Forward View on strengthening general practice and giving GPs a central role in developing new models of care integrated around patients; and calls on the Secretary of State for Health to work with NHS England and the RCGP to secure the financial future of local GP services as a matter of urgency.
	I am grateful to the Backbench Business Committee for providing the House with the opportunity to debate the important subject of sustainable GP services. I am also grateful for colleagues’ support for the debate application. Some of those Members are here, including the hon. Member for Brighton, Pavilion (Caroline Lucas), who spoke in the Committee in support of the application as a co-sponsor.
	The debate is timely, given the increasing pressures on the NHS and its hard-working staff. I put on record my appreciation for the hard work and dedication of doctors, nurses and all the staff who work in our health service. Their dedication is keeping the health service going at a particularly difficult time. I also want to put on the record my thanks to the Royal College of General Practitioners for its support, the information it has provided and its campaign.
	One of the key reasons for seeking the debate is that, increasingly, constituents have been contacting me to tell me that it is becoming more difficult to get an appointment with a GP of their choice without having to wait many days or even weeks. Sometimes they are not able to see the GP of their choice at all. That, of course, varies between practices. There is no doubt that the overwhelming majority of GPs do an excellent job. That has been demonstrated by patient surveys, but there is always room for improvement.
	There is little doubt about the growing demands on general practice caused by demographic changes and more complex health needs, exacerbated by an ageing population. Increasingly, a large part of GPs’ daily work load is on mental health, which would probably merit a debate in itself. That matter needs to be addressed continuously.

Philip Hollobone: I am enjoying the start of the hon. Gentleman’s speech immensely. He has raised an important issue for my constituents. Does he agree that there are also demographic pressures
	within the GP service in that many of them are in their 50s and about to reach retirement? All of a sudden, we will have a dearth of experienced GPs, which will be a difficult gap to fill.

Derek Twigg: The hon. Gentleman raises an important point and he is absolutely correct. I will refer to that later in my speech.
	There can be no doubt that GP recruitment has not kept up with the demands of our population. That is the key problem today. In addition, the pressure on hospitals has increased massively because, if people cannot see their GP they often go to A and E. That has been a problem in areas such as mine. There is also the inability of hospitals to discharge frail, elderly people from wards into the community because of the shortage of care in the community. Councils face massive budget cuts, so there are pressures all round. There are pressures on GPs in relation to access and there are pressures on hospitals and elsewhere.
	I want to raise a particularly important point with the Minister that I have raised before. The Government are proposing to demand a 3.8% efficiency saving in the national tariff for 2015-16. That will push many hospitals to breaking point and possibly endanger patient safety. I hope that the Minister will look at that again. Members should read the briefing on that from NHS Providers.
	There is clearly a view among many that general practice is heading for some sort of crisis. One GP in Halton told me recently:
	“The overwhelming problem is the manpower crisis and the rock bottom morale of the Profession, which are interlinked. We are unable to recruit new GPs into practice or medical students into our specialty, training places are left unfilled and there are vacancies all over the country with very few applicants.”
	It is hardly surprising we have that problem when we consider what the RCGP has said:
	“Funding for general practice has fallen to an all-time low of only 8.3% of the overall NHS budget…GP surgeries are now seeing 372 million patients a day, compared to 300 million a day in 2008.”
	Some family doctors are seeing 40 to 60 patients a day. That is unsustainable in the long term. Some 49% of GPs say that they can no longer guarantee safe care to their patients.
	The RCGP tells me that the average coverage is 6.9 GPs per 10,000 of population. That is the lowest level of coverage since 2011. The RCGP estimates that up to 543 practices in England could face closure due to the fact that 90% of GPs working in those practices are 60 or over or are likely to retire soon. The hon. Member for Kettering (Mr Hollobone) made that point.

Stephen McCabe: I certainly agree with my hon. Friend’s point, but does he also agree that the constant stop-go policies and the changes in contracts and the confusion over NHS England and clinical commissioning groups is adding to that problem? In my constituency we have the Bournbrook Varsity practice. It expanded and did everything that was asked of it by the primary care trust to create a broader health service. It now finds itself about to be penalised, have its funding cut and have to reduce staff in an area where there is a huge student population. Those students will inevitably gravitate to A and E if this service goes.

Derek Twigg: My hon. Friend raises an important point, and I know how committed he is to having a well-run health service. That is an important issue for his constituency. The structural changes that take place on a regular basis have been one of the complaints made by people who work in the health service.

Barry Sheerman: In the most stressful bits of the GP world, GPs are retiring very early, which is a great loss and is very worrying. I have met two GPs recently who are retiring very early with so much still left to give. We are also finding that among A and E specialists. What a strange world it is when we cannot recruit doctors into general practice or A and E at a time when we need them so much.

Derek Twigg: My hon. Friend makes a powerful point and he is absolutely spot-on. That links with the comments made by other Members about GPs deciding to retire early because of the pressures and because they feel their profession is being let down and is not what it was when they began their career. Getting younger people into the profession is becoming more difficult. I will come to that.
	The British Medical Association is concerned that there are inadequate numbers of GPs to meet the demand of a rising population, and in recent years annual increases in the number of GPs have been lower than the rate of population growth. That is a key part of this argument. The number of GPs we need is just not keeping up with the demands of the population.

Mark Prisk: I congratulate the hon. Gentleman on securing this important debate. My own GPs, who do a fantastic job in Hertford, Ware and Bishops Stortford, say to me that while the pressures of the job are a critical reason why some are retiring early, one of the other problems is the change in the way people are trained, which is driving people away from general practice into other specialties. Does the hon. Gentleman agree with that analysis, and what do we need to do to change it?

Derek Twigg: As I will come to later in my speech, there are a number of things that the Government coming into office after the May election will have to deal with to address the sustainability of GP services. They will have to consider whether the training is correct and whether there are enough incentives for young people to go into general practice, or, indeed, other parts of the NHS. That will be an important part of any sustainable plan to make sure we have enough doctors throughout the health service, and in particular GPs. That is a point that needs addressing.
	The British Medical Association is also concerned that not enough foundation doctors are choosing to pursue a career in general practice. Application rates for training programmes continue to fall year on year. According to figures from the National Recruitment Office for GP Training, the number of applications for 2014 was 5,477, which was a reduction from 6,034 in 2013. I am told that this is leaving GP vacancies unfilled in parts of the UK: in the east midlands and Merseyside just 62% and 72% respectively of vacancies are filled. To come back to the point Members have been making, 9% of the general practice work force are aged over 60 and 38% are aged 50 or over. Just 27% of the general practice work force are under 40 years of age.
	One of the reasons for speaking today is to deal with the access problems. I am sure most, if not all, MPs will have had complaints about that raised with them by constituents and by GPs.
	Last year, Healthwatch Halton carried out a GP access and out-of-hours provision survey, and it is important to share some of the key results with the House: 56% of people rated booking an appointment with their GP as “very difficult” or “not easy”; 33% of people rated the length of time it took to get through to their GP practice as “poor” or “very poor”; and 62% of people would like their practice to be open longer, particularly at weekends and in the evenings. That is a particularly important point when considering whether GPs are accessible and we should move to weekend working, which we have had and are debating. However, doing that requires resources. Importantly, a sizeable proportion—32%—were unhappy with the way in which their complaints were handled. That is roughly in line with national findings. On the very big plus side, the general satisfaction level of people with their GP was more than 90%, which is important.
	The figures provided to me for Halton by the Royal College of General Practitioners—my constituency covers most but not all of Halton; some is covered by the hon. Member for Weaver Vale (Graham Evans)—show that we have 66 full-time equivalent GPs and that we need to increase that by 24, or 37%, by 2020. In one of the most deprived boroughs in the country we already have a shortage of GPs. My area deals with some of the most difficult health problems—high cancer rates, and high levels of chest disease and of heart disease—so being able to access a GP, and quickly, is very important. Any shortage has an impact on all that.

Anne-Marie Morris: The hon. Gentleman makes a good point about access and about the challenges in deprived communities. In Newton Abbot, we have faced a real challenge in trying to replace the services there. Does the research he refers to indicate any difference between rural and urban communities, and between deprived and well-heeled communities?

Derek Twigg: I cannot answer the hon. Lady’s question because I do not have those figures in front of me. I am sure that if she talks to the Royal College of General Practitioners or the BMA she will be able to find all those figures. I am sure she understands that I represent one of the most deprived urban constituencies in the country and so I am going to focus on that, as I am sure she would focus on her constituency.
	Let me re-emphasise a point I made earlier: whoever forms the Government after 7 May, they will have to come forward with solutions to the mounting pressure on general practice and the NHS overall. There needs to be long-term, sustainable investment in GP services in order to attract, retain and expand the number of GPs. Retention is just as important as recruitment—a point made in the comments about GPs retiring early.

Simon Burns: The hon. Gentleman raises an important issue. A significant amount of house building is going on and will be needed in the near future. Does he agree that to encourage people into
	general practice and to minimise the pressures, planning for any significant amounts of new housing should include health centres and facilities for GP practices, so as to make it easier for GP practices to be able to go to such places?

Derek Twigg: The right hon. Gentleman makes an important point. Clearly, if there is a large housing development or one that results in a large population increase in an area of the country, planning for that should include the need for proper GP services. Of course to do that we need more GPs—that is a crucial part of it. The other point to make, which other Members may want to raise in the debate, is that we also need good facilities and buildings, because unless we have those we are not going to attract as many people into general practice. Some facilities and buildings around the country, including some I have had in my constituency, are just not up to the job. Trying then to get new facilities or new buildings built, or passed through the NHS system, is remarkably difficult and takes years. I can give examples of that in my constituency. The right hon. Gentleman raises an important point, but we need to have more GPs to do what he suggests.
	I am conscious that other Members wish to speak, but I want briefly to discuss the Government’s record. Like others, I believe strongly that the Government made a major mistake in embarking on a massive reorganisation of the NHS, despite saying that they would not do so, which according to different estimates has cost between £2 billion and £3 billion. Whatever my political differences, why do I think that was such a major mistake? Well, it distracted the health service at a time when it was under massive pressure, and used up crucial resources. The massive increase in financial pressure was also building.
	As a result of the creation of the clinical commissioning groups, many GPs have had to spend more time away from their surgeries. Let me just add that the CCG in Halton works very well; it is very progressive and forward thinking. It is determined to try to improve health and has worked very well in partnership with the local borough council. But the health service was distracted by the change, which cost a lot of money and took away vital time and resources that should have been put into ensuring that we had the right number of GPs and the organisation that we needed.
	This Government have not done nearly enough to prevent the shortage of GPs. We are still waiting to see whether their plans will add up and create the number of new GPs that we need. I was shocked by one revelation. I would have thought that if someone wanted to decide on the number of GPs that are needed, they would have to know how many vacancies there were, but when I tabled a parliamentary question recently, I found out that the Government no longer kept a record of GP vacancies. I then asked the House of Commons Library how that could be. It told me that the survey suspension coincided with a fundamental review of data returns, which was initiated by the present Government in September 2010 in response to a commitment in the White Paper, “Equity and Excellence: Liberating the NHS” to
	“initiate a fundamental review of data returns, with the aim of culling returns of limited value.”
	How such information on GP vacancies could be deemed as being of “limited value” is a mystery to me.
	The Library has also told me that Health Education England’s work force plan indicates an estimated gap of around 3,000 full-time equivalent GPs between the number of staff in post and the forecast demand. I understand that the Government are saying that the supply and demand gap is expected to close by 2020 if an additional 3,100 new GP trainees can be found every year, but we have already heard about the problem of recruiting trainees to work in general practice.
	Dr Maureen Baker, chair of the Royal College of General Practitioners, said that the threat was one element of a “shocking” wider crisis in front-line community care, with more than 1,000 GPs expected to leave the profession every year by 2022. The number of unfilled GP posts has nearly quadrupled in the past three years to 7.9% in 2013. The RCGP has estimated that we need some 8,000 more GPs in England, and 10,000 across the UK, by the end of the next Parliament in order to meet growing demand from patients.
	The Government’s decision to get rid of NHS Direct and replace it with NHS 111 was short-sighted. Members do not have to take my word on that. They can just listen to the words of a GP in my constituency, who said:
	“NHS 111 has been a complete disaster. Lay people/call centre staff working from a crib sheet/flow chart are creating huge demand in both primary care and A and E. Quite a bit of controversy about this in the last few days. They call for ambulances at the drop of a hat and seldom advise the patient to self-care. The callers not admitted are advised to see their GP within a few hours. The contact summaries are unintelligible.”
	Those words are not mine but those of a GP: NHS 111 has caused some real concerns.
	The Government have also cut GP training. The shortage of GPs is, without doubt, one reason why we are finding it harder to see a GP. It is also holding back the NHS from meeting the challenges of the future, such as providing better care outside hospital to support an ageing population. Of course the right hon. Member for Chelmsford (Mr Burns) will remember that that was one of the key reasons why the Government introduced the Bill they did.
	My right hon. Friend the Member for Leigh (Andy Burnham) has stated that a future Government will raise something like £2.5 billion for a “time to care” fund from a mansion tax on properties worth more than £2 million, cracking down on tax avoidance and a new levy on tobacco firms. Such investment will enable a Labour Government, by the end of the next Parliament, to provide 20,000 more nurses and 8,000 more GPs to help people stay healthy outside hospital and to tackle GP access problems.
	In 1997, only half of patients could see a GP within 48 hours. The previous Labour Government rescued the NHS after years of Tory neglect. By the time we left office, 98% of patients were being seen within four hours at A and E and the vast majority of patients—80%—could get a GP appointment within 48 hours.
	One of the Prime Minister’s first acts was to scrap Labour’s guarantee of getting a GP appointment in 48 hours and to cut the funding for extended opening hours.

Daniel Poulter: The hon. Gentleman is making some important points, but does he recognise the fact
	that it takes a number of years to train any medical specialist, including a GP? While he is talking about the previous Government’s investment in the NHS, would he like to explain why that forward work force planning was not done and how such planning may have helped with some of the issues that he is raising today?

Derek Twigg: The Minister makes an interesting point. At Prime Minister’s Question Time, we keep hearing the Prime Minister say, “Look how many extra GPs and nurses we have recruited,” but how long does it take to train them? I suggest that the Minister look at the figures on the number of additional GPs and nurses recruited between 2003 and 2009.

Henry Bellingham: What is the hon. Gentleman’s view on the last Labour Government’s decision to change GPs’ contracts to relieve them of out-of-hours cover?

Derek Twigg: Again, that is an interesting point. There is a perception that every GP practice provided out-of-hours cover with the GPs themselves going out to see their patients. Of course, some of them did that, but many did not. Many of them were already using locums. During my childhood, I was a particularly bad asthmatic, and most of the doctors who came out to see me were locums, not my GP. We must look at how we organise out-of-hours services, but the key thing to focus on today is that we have not got enough GPs.

Daniel Poulter: On long-term work force planning, the hon. Gentleman suggests that there is suddenly a crisis in GP recruitment—which I do not think is necessarily correct—but if the previous Government were serious about investing in general practice, they should have trained a lot more GPs than they did.

Derek Twigg: I know the Minister’s background, but he should read the figures on the number of GPs recruited by Labour when we were in power. Between 2000 and 2009, there were thousands of extra GPs, compared with the additional recruitment since this Government came to power. He should compare the two records.
	I will not take any more interventions, Mr Speaker, because other Members want to speak.
	Many local initiatives are trying to deal with the crisis in general practice and gaining access to GPs, or certainly to mitigate the effect. Clinical commissioning groups, such as Halton CCG, are working closely with partners to develop a strategy within the financial constraints. Halton CCG has told me:
	“Delivery may be across the whole CCG on a Halton-wide footprint; by bringing more than one GP practice together to service distinct communities through a ‘hub’ based approach; by sustaining individual practices wherever appropriate and by giving local people and communities more opportunities to self-care and create resilience”.
	It is working with partners to try to improve the situation, despite the financial constraints and the shortage of GPs, but we must attract more GPs.
	The Royal College of GPs has told me that, in its view, it is vital that we increase the share of the NHS budget spent on general practice in England from 8.3% to 11%. That is one of the key parts of its campaign.
	That increase would help to reduce pressure on other parts of the NHS by supporting the delivery of more patient care in the community and keeping people out of hospital wherever possible.
	The fact is that general practice cannot go on in this state. We need a sustainable, funded plan to ensure we have enough GPs to meet the population’s needs and to provide better care outside hospital. Clearly, patients should not have to wait days and sometimes weeks to see a GP or be constantly denied the opportunity to see the GP of their choice. We need to relieve the pressure on hard-pressed GPs, by ensuring that general practice is where more young doctors want a career, and in doing so we would have much better integrated care. We need better buildings to make general practice a more attractive place. We must of course constantly challenge the medical profession on how they can work better and deliver better services to patients within available resources. In the end, both politicians and clinicians must put the interests of patients first, while getting the best value for the taxpayer.

Several hon. Members: rose—

Mr Speaker: Order. I am extremely grateful to the hon. Member for Halton (Derek Twigg) for his courtesy and consideration of other Members. I was not intending to impose a formal limit on Back-Bench speeches, but it might be helpful to the House to know that 12 Back Benchers want to speak in the first debate and seven in the second. This debate might run until approximately 2.30 pm. If Members can confine themselves to 10 minutes, there should be no difficulty and it will be possible to accommodate everyone.

John Howell: It is a great pleasure to follow the hon. Member for Halton (Derek Twigg). I congratulate him on securing this debate, which highlights a very important subject.
	Over the past few months, I have had discussions with GP practices across my constituency. I have had a number of meetings with GPs, usually during their lunch hour, and we have covered a wide range of topics, some relating to the new hospital being built in Henley as a re-provision of the old one, and some relating to the individual situation of GPs. These discussions arose out of my speaking to a conference of GP practice managers. It is important to stress the crucial role of managers in running GPs’ practices. There was a lot of agreement between myself and the right hon. Member for Oxford East (Mr Smith) about how the health service is organised. My meetings with GPs have also come about as a result of talking to patient groups.
	GPs are excited at the possibility of providing a range of services, through new methods, in the hospital in Henley, and are very much part of the discussion with the CCG on this. There is a real possibility of an emergency multidisciplinary unit there.
	When talking to GPs, I have raised the subject of access to GPs and services. In my constituency, access is not an issue. If people need urgent appointments, GPs will make themselves available. People can ring for an
	appointment and be given one very quickly. I have found that to be the case with my own surgery, for example, and I applaud the dedication and the willingness to work in co-operation that have been shown by GPs in these circumstances. Sometimes, though, if people ask to see a specific GP urgently, that may not be possible, but these are small practices where there is good communication and discussion of medical issues between the limited number of doctors there. Access does become a problem when practices are essentially outposts of another practice. This occurs in the north of my constituency in a village called Chinnor, where the practices are outposts of practices across the border in Princes Risborough. Managing that can create certain problems for GPs.
	The major problem put to me by GPs is patient expectations. I would not want to limit patients’ genuine expectation of good service provided in a timely manner, but we expect things without a wait, so the issue is the expectation, rather than the GP’s availability.

Michael Fabricant: Does my hon. Friend agree that another problem facing GPs and the NHS in general is patients who make appointments with GPs and consultants and do not turn up?

John Howell: If my hon. Friend will give me a chance, I will come to that very point, which is one that I discussed with GPs and patient groups.
	There is also the expectation of what a GP can do. The number of visits per patient may be up, which is increasing demand, but the causes, according to GPs, are, first, the desire for an instant cure. People are not giving minor ailments time to heal themselves, but expect medicine on tap for everything. Thus going to a GP as soon as symptoms occur is part of the expectation. Secondly, people are motivated to see their GP by advertisements listing symptoms and encouraging people to go to a GP if they have them.

Liz McInnes: rose—

Duncan Hames: rose—

John Howell: I give way to the hon. Member for Heywood and Middleton (Liz McInnes).

Liz McInnes: The hon. Gentleman talks about patient expectations, but in the Heywood, Middleton and Rochdale CCG, which serves my constituency, 16% of patients report that they are unable even to speak to somebody to get an appointment. I do not think it is an unreasonable expectation that patients should be able to contact somebody who can get them an appointment with a GP.

John Howell: I will give way to the hon. Member for Chippenham (Duncan Hames) and then respond to both interventions.

Duncan Hames: I do not find fault with the patients, but does the hon. Gentleman agree that a significant difference between the funding patterns for primary and secondary care is that in secondary care the more treatment provided and the more patients seen, the more funding provided by commissioners to the provider, yet the same pattern, where funding is proportionate to the amount of activity undertaken, is not typically seen in what we ask of general practice?

John Howell: I will talk a bit about funding later. I say to the hon. Member for Heywood and Middleton that we are trying to put together a picture on the basis of individual constituencies. It is no use taking an overall, theoretical picture and then trying to work out what is happening in individual constituencies; it has to be done the other way around, by individual constituencies saying what is happening with them. I am setting out precisely the situation in my constituency.

Richard Graham: On that point, in Gloucester we had exactly the same problem that Members have referred to, so our clinical commissioning group managed to arrange funding for 300 additional hours in GP surgeries a week, which is proving very effective. That is the sort of thing that can be done locally by using the budget creatively. Does my hon. Friend agree that others might be able to explore that?

John Howell: I agree that that is a very good local initiative that could be spread across general practice.
	Let me give the House an example. I happened to be visiting a surgery one afternoon, so I asked the staff what the problem with access was. I was told that a good example was a lady who had come in that morning to have her plaster changed. I imaged plaster being removed from a suppurating wound, but it was actually a small plaster on her hand. She was told to go away. I think that is an abuse of a GP practice by a patient.

Henry Bellingham: Will my hon. Friend consider the role of pharmacies in providing more cover and more care, for example for the type of complaint he has just mentioned? Surely those people should be going to their local pharmacy, rather than their GP practice.

John Howell: I completely agree. If I manage to get through my speech, I will say a few words about that.
	The way forward is for patients to take responsibility for their own health, but there is a basic education point that stands in the way. I have a minor condition that requires my blood pressure to be monitored. I do that myself at home, and then send the results remotely to the surgery. We then have a conversation about it remotely, hopefully by e-mail. It is ironic that the internet is increasingly used by the over-50s, but the view of GPs providing a public service stands in the way of, and even contradicts, the over-50s being able to use the internet to achieve that result.

Simon Burns: Is there not also a problem with some patients using the internet to self-diagnose, as there can sometimes be unpleasantness and arguments when GPs do not agree?

John Howell: That risk does exist, but I am talking about a treatment regime that I have agreed with my local practice, and this is the best way of dealing with it.
	I have discussed the impact of no-shows with local practices. No-shows can affect surgeries by denying appointments that are the equivalent of up to one doctor each week. We looked with patient groups at various ways of dealing with that, including a ring-back system that allows surgeries to send text messages to remind patients not to forget an appointment the following day. What is missing, though, is an ability for the patient
	to ring back and say, “Yes, I’m coming”, or “No, I’m not coming.” I understand that the scheme that was going to put that in place centrally has been cancelled, and I ask the Minister to look at that carefully. Some practices use no-shows positively as a potential indication of symptoms; if someone is a consistent no-show, that might be a sign of dementia or something else. When I discussed charging for no-shows with patient groups, there was great hostility to this, tempered by the admission that it was administratively impossible and raised too many issues about access to services.
	The hon. Member for Halton talked about the role of GPs in planning locally. I have asked about this in my area, where a whole lot of places are going for neighbourhood plans. I fully support them in doing that. It is the first time that communities have had the ability to determine where houses will go—and, indeed, what they will look like, because there is a very important design element. When I asked GPs what role they had in the neighbourhood planning process, the answer, basically, was none at all; they had not participated in the discussions. I sent them back to have those discussions with the people putting the neighbourhood plan together. This cannot be left to the CCG to determine for GP practices; GP practices have to do it themselves. The risk is that if they do not have their wish-list regarding what is to be done, they will lose out in the allocation of community infrastructure levy money that will eventually come through.

Mark Prisk: On the development of local plans, in east Hertfordshire and elsewhere, the problem is that our rather nice, but historical and inadequate, premises restrain the ability of practices to provide modern facilities. Is that my hon. Friend’s experience of the local planning process in his constituency?

Lindsay Hoyle: Order. May I make a suggestion? The Speaker suggested a time limit of about 10 minutes, and the hon. Gentleman has now had 13 minutes. I hope there will not be too many more interventions, and that the hon. Gentleman is coming to the end of his speech.

John Howell: Thank you, Mr Deputy Speaker. I am coming to the end, but let me answer my hon. Friend’s intervention. It depends on where the practice is and what its buildings are like. Some are quite modern, and one would not want to change their facilities. Even those practices may need to add an extra surgery, if the village is going to grow by several thousand people, so they need to plan for where it will go and for the doctor that will use it.
	The trend in the population has been towards more elderly patients and more patients with long-term, chronic or multiple conditions. That leads to an increase in the number of patients per year. There is no doubt that the age profile is having an impact. The Government’s allocation of a named doctor to a patient is useful for the co-ordination of services, even though in an emergency the patient may not be able to see that doctor on the day when they require them.
	Yes, there is a need for money to be provided for GP services, but this is possible only if we have a strong economy. The Government have evened out the payments between practices so that they do similar things in
	similar parts of the country and there are not wide variations between them. That has to be the right way to go. It also has to be right to increase the strength of the economy in order to provide these services.

Stella Creasy: I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing what, for me, is an incredibly important debate. I am pleased to follow the hon. Member for Henley (John Howell), because he and I have probably been doing the same thing in going to talk to people in our local community about local health care. I must say that my experience is of a very different health care system—one that is under real pressure and, frankly, very much in danger in my local community.
	I wanted to speak in this debate to put my concerns on the record and to ask the Minister and officials at the Department of Health to look at my area, because I am so worried about these issues. As an MP, I see it as my job first and foremost to help the patients of Walthamstow—my neighbours, as well as my family and friends in the area—who can see how our services are falling apart. As their MP, my very real worry is that, as much as I have tried to raise such concerns, all I hear is that those problems are for someone else or for some other organisation to resolve. I want to put on the record some of the issues, and to explain the situation in our local community and how it is having an impact on doctors. By doing so, I hope to convince the Minister to pay special attention to Waltham Forest.
	There are 45 GP member practices in Waltham Forest CCG. We have one of the fastest growing populations in the country, but many of the practices are in poorly maintained buildings and are single-handed. They serve a community that has a very high incidence of what we might call lifestyle diseases—diabetes, heart disease, cancer—and GP access is absolutely critical to the outcomes achieved for patients.

George Howarth: Will my hon. Friend be a bit more specific? Type 2 diabetes is lifestyle-related, but type 1 is not.

Stella Creasy: I apologise for using shorthand. My right hon. Friend is completely right. I am talking about type 2 diabetes. For example, many people from the south Asian community in my constituency have type 2 diabetes.
	We are told that our local GP work force needs to grow by 40% by the end of the next Parliament if it is to serve the community I represent. However, I can already see very real problems with our local community service, and that is bad for the patients and for the rest of the NHS. We know how difficult it is to recruit and retain doctors, but in my part of town, with the high cost of living in London, it will get even harder.
	Since 2011, complaints about GP access have rolled into my constituency office. Let me give the Minister some examples. Just the other day, a resident rang me and said: “Look, the receptionists were perfectly polite. They said call at 9 o’clock or queue up before the surgery opens to get an appointment, but the line was
	constantly engaged from 9 o’clock. My phone shows I called 28 times between 9 am and 9.30 am, and I could not get through. When I did get through, it was only to be told that there were no more appointments left.” That is not unusual in my community.
	Little wonder that residents in Walthamstow routinely report that it takes two weeks to get an appointment with a doctor. Nationally, we know that one in four people wait a week or more. The problem—this is why I disagree with the hon. Gentleman—is that it is very hard for people to know whether or not they need to see a doctor, especially if they are worried about a child.
	Let me give another example of a complaint I received just the other day: “I have had constant problems trying to get a GP appointment for my 13-month-old daughter since she was born. A couple of times, even only last week, I was asked by reception staff at the doctors why I hadn’t gone to A and E.” That is the constant question for residents in my local community when they cannot get through to the surgery—should they wait or should they go to A and E?
	I agree with the hon. Gentleman that not everybody needs to see a doctor, but another resident told me: “I fell and cut my hand deeply on glass. I went to the doctors to ask if a nurse could check that there was no glass left in. They told me to go to hospital. The cut was really not that bad. But they said they don’t have any nurses on a Friday and I would have to make an appointment to see a nurse—two weeks as usual, no doubt—so I just left it, as I do with most pains, coughs or small lumps, and hoped it would sort itself out. My hand is healing now and seems to be glass-free. I hope so anyway.” That is not unusual in my area. At least that elderly lady could have seen a nurse, but many constituents tell me that they do not bother to see a doctor because of how long that takes, and they take the risk of waiting.

Douglas Carswell: I am very interested in what the hon. Lady is saying, because it sounds ominously like the situation in Clacton. Indeed, in one Frinton surgery in my constituency, one doctor was trying to serve 8,000 patients. She is absolutely right to avoid the temptation to blame the patients or to suggest that they are the problem. Does she agree that part of the answer is to ensure there are far more attractive terms for would-be GPs? That does not necessarily mean higher salaries—

Lindsay Hoyle: Order. Mr Carswell, interventions are meant to be short, not speeches. I am sure you have got to the point.

Stella Creasy: It is unusual for me to agree with the hon. Gentleman, but I agree that we need to look at how we can attract and retain doctors. We also need to look at what these problems do to the rest of the NHS.
	Let me tell the hon. Gentleman about a constituent of mine who had a problem with his eyesight that was caused by high blood pressure. Because he could not get a doctor’s appointment, he left the condition alone. He has now gone blind in one eye and his other eye is at risk. His elderly wife came to me because she did not want to bother the doctor. We have to change that culture and to consider the consequences of not using our resources to deal with those early problems. When
	we leave somebody like that and they end up going blind, the cost to all of us to help them is much greater than if they had been able to access a GP. We must look at the terms of the job, but also at where the resources are not going. I have been raising those questions with local health care providers.

Michael Fabricant: I am very interested in what the hon. Lady has to say. She said that in her constituency—she must tell me if I have got this wrong—there are a large number of single-doctor practices. Does she not think that that is the cause of the problems, and that the Government should encourage practices to consist of a number of doctors working together?

Stella Creasy: Although I am a doctor, I am not a medical doctor, so I warn the hon. Gentleman that if he needs treatment, he should not come and see me. However, I could tell him why he has no friends—that is the sort of doctorate I have.
	There are many issues and the number of single practices might be one of them. My point is that nobody has got a grip of this issue over the past couple of years, despite the fact that I, as the Member of Parliament, have raised concerns. In 2011, the complaints about access to GPs started coming in. I went to the primary care trust, but because of the reorganisation of the NHS, nobody was interested in the case that we were trying to make. The PCT said, “Wait until the CCG is organised.” I tried the new CCG, but six months after saying that it would look into the repeated complaints that I had raised, it said that this was not its issue and told me to go to NHS England.
	Initially, NHS England told me that I could not raise the issues on behalf of patients because of patient confidentiality. It could not respond to any of the concerns that I was raising because they related to patient records. It then tried to say that unless the residents had complained to the GPs about GP access, it would not look into the issue, even though I had a binder full of complaints, which showed that it was a problem not just with an individual practice, but with many local practices in my local community. There was widespread concern. The problem continued and, eventually, NHS England came back to me and said, “It’s all right. We’ve spoken to the practices and they have said that if people want an appointment, they can ring up and get one.” It was a circular and deeply frustrating experience.

Henry Bellingham: Will the hon. Lady give way?

Stella Creasy: I will happily give way one last time, but then I want to get on.

Henry Bellingham: I understand the hon. Lady’s annoyance and frustration with her CCG and local health service. In my patch, the CCG is chaired by a GP. It has been incredibly responsive to my concerns and has worked with GP practices. I am just sorry that she has not found that in her patch.

Stella Creasy: I appreciate that that is the hon. Gentleman’s experience. This is precisely my point: why is nobody taking a strategic view of these issues?
	I will give the hon. Gentleman an example and it goes to the heart of what the hon. Member for Henley was saying. One concern that people have raised is about
	missed appointments. The appointments that doctors give people do not always match the times when people need to see them. There is no recording of missed appointments because of the fragmentation of the NHS. Who should take responsibility for that?
	A snapshot survey that my CCG did, possibly because of nagging from me, showed that on average 10% of appointments are missed in my local community. However, that is an average. In one surgery, 40% of appointments are missed and in another only 12% of pre-booked appointments are used. Irrespective of whether that is just because patients are missing appointments or because appointments are not at the right time, it is a waste of resources. Surely there is a public interest in having a central co-ordinating body that looks at these issues and at where there are problems in the NHS. It is a waste of money for everyone concerned. Crucially for my constituents, it means that they are not getting access to doctors, even though there may well be the facilities to see them.
	Even if people can get access to a doctor, the quality of the practices in my local community is very poor. I know that other Member have raised similar concerns. That might be one reason why it is difficult to retain doctors. I have one practice that has been waiting 25 years to be rebuilt. It serves 12,000 patients. Because of the poor quality of the facilities, it cannot offer some basic services such as blood tests. It has not had central heating since January 2014. That is not an acceptable environment in which to provide a health care service.
	The problems with GPs in Walthamstow are not just about the facilities. Since becoming an MP, I have worked with a group called WoWstow, which is a group of women who are fighting to get basic sexual health care services in Walthamstow, because we do not have them. When I talk about basic sexual health care services, I am talking about the provision of contraception, the provision of the coil and the provision of basic facilities to help women maintain their public health. We have doctors who refuse to prescribe such things, and then people wonder why my local area has a level of sexually transmitted diseases that is significantly worse than the national average.
	There have been widespread complaints about other doctors, to the extent that the General Medical Council is involved. As far as I can see, there is little concern about how we deal with patients who are asked to go to doctors in respect of whom there are known to be concerns about the quality of care that they provide. Nobody is picking up the pieces. Nobody is gripping the issue to ensure that we do not see health care problems in my local community, which very much needs to be able to access GPs.
	As my hon. Friend the Member for Halton has set out, all of this means that there are pressures on my local hospital, Whipps Cross university hospital. There are concerns about Whipps Cross itself. One resident wrote to me to say, “All I want is to be able to get an appointment for my child and not have to worry that if she or another member of my family ended up at Whipps I would have to fear for our lives, and that is not an exaggeration.” Barts Health, which runs my local hospital, is a large provider of acute services. It serves a population of 2.5 million in north-east London. The Care Quality Commission has taken enforcement action against it in the past couple of years because of the quality of care.
	The CQC pointed out that if patients in my local community had access to an urgent care centre, they would be able to see somebody and it would improve the quality of care. However, I have just been told out of the blue that the commissioning process for more urgent care centres has been paused because of a lack of remaining bidders. Again, that is a separate part of the NHS from the GP surgeries and the hospitals that is also trying to deal with patients. The system is fragmented and piecemeal, and that is causing problems in a community that needs health care. Without the urgent care centres, there is a risk that many of the health care services in Walthamstow will simply collapse.
	I have written to the Secretary of State about GP access. I have raised it with the CCG and NHS England. We have even organised local patients to act as mystery shoppers and go to doctors’ surgeries to ask to join their patient involvement groups. Not one of those people has been able to join a patient involvement group. That is a problem.
	In 1958, Nye Bevan spoke in this place about the point of the NHS:
	“Many people have died and many have suffered not because the knowledge was not there, but because they did not have access to it. To all the suffering which attends illness, there was always added the bitterness that, if the poor could have had access to the knowledge available, they might have been saved or, at least, might have been helped. It was this situation that the National Health Service was intended to put right.”—[Official Report, 30 July 1958; Vol. 592, c. 1383.]
	Sixty-seven years later, the same concerns remain for a new generation of patients facing lifestyle diseases. I am making an open plea to Ministers at the Department of Health urgently to review the provision of health care in Waltham Forest. Please, let us not make early diagnosis a provision only for the rich in this country.

Sarah Newton: I am very proud to be part of a governing team that has spent more money on the NHS. We faced some incredibly difficult choices when the coalition was formed and protecting the NHS was at the top of our list. I have seen for myself some of the benefits of the reforms. Many more decisions about NHS services are now taken in Cornwall, led by clinicians and local people. That is very welcome.
	I very much welcome the “Five Year Forward View” that NHS England has put together to cope with the considerable increase in demand on the NHS that is anticipated. Whoever is in government will face the challenge of how we can deliver the first-class services that everyone in this House wants for every constituent in every part of the country.
	In the short time that I have, I will share with the House four observations that I have made from talking to staff in the NHS in Cornwall and to patient groups in my constituency, and we could usefully take them forward to help us to tackle some of the challenges we will face in the future.
	The first is the role that women can play in addressing some of the work force challenges faced by the NHS as a whole and, in particular, by general practice. The
	second is how we can expand the services provided by GPs’ surgeries. The third is the role that GPs can play in A and E departments, and fourthly I wish to share some of the learning we have had from our great fortune in Cornwall in being part of the integration pioneer.

John Redwood: Does my hon. Friend agree that our party’s excellent policy of extending GP opening times and days is crucial, but it will require more GPs to work more flexible hours on an agreed basis?

Sarah Newton: My right hon. Friend makes a good point. The plan that NHS England has put forward is about shifting resources from the acute emergency care sector into primary care sectors, especially GP practices. The point that he makes about flexible working fits well with my point about enabling more women to stay in the NHS or to return to it. Many walks of life are addressing the issue of enabling women to combine their caring responsibilities with their desire to play a full part in society, whether that is in public service as a GP, as a Member of Parliament or in business. Much more work needs to be done by the NHS to look at ways to enable women to combine caring for children or elderly parents with being a GP or fulfilling other roles in the NHS.
	Women often take a break to look after their families—it is something that I did myself—and it can be difficult for women in their late 30s or 40s to find the ladder back into their previous careers and occupations. I note that many former GPs could make excellent GPs again if they were given the opportunities to retrain and reskill. They could contribute enormously, through working flexibly, to enable GP practices to open more hours.

Daniel Poulter: My hon. Friend makes an important point. I hope that she will welcome the opportunity we may have to revisit the issue of the annual performers list. At the moment that means that if a GP is out of practice for a year, it is very difficult to return. That is something that we need to address, and I hope that she will be supportive of the Government’s efforts to address it with NHS England.

Sarah Newton: I welcome the Minister’s intervention. That sounds like an excellent initiative and I am sure that more will follow, because we need to use the talents of everyone in our nation to address the challenges that we face. Women can play an enormously important role in the NHS, as they can in all other walks of life.

Michael Fabricant: I was very interested in the intervention from the Minister, who is of course also a GP. I was also impressed by some of the points made by the hon. Member for Walthamstow (Stella Creasy) about sole GP practices. If we are to have flexibility, so that people can go and see doctors quickly and to enable women and others to go back to work as GPs, it surely requires multi-GP practices, not sole practices. Otherwise, it is just not practical.

Sarah Newton: That is a good point. We have to look at how general practices are set up these days. Not all general practitioners want to be part of the old partnership model, which is a sort of small business. Many now would like to be salaried and work particular hours in
	particular settings. I would not want to prescribe a particular model: we need to look flexibly at different models of provision that meet patients’ needs, taking into consideration what the work force need to enable them to play their full part.
	GP practices in my area are expanding the range of services that they are able to provide to the community. As hon. Members will know, I represent a large, remote, sparsely populated part of the country, and such expansion is especially important for rural areas. One example is the Probus surgery of GPs, which serves many villages in its rural community. It is expanding into many areas, including minor surgery. I have yet to come across anyone who has anything other than praise for the Probus surgery, which provides the normal services one would expect from a surgery, but also works closely with its primary care partners and district nurses. It also links up with care managers for people with chronic conditions and elderly people living at home.
	By comparison, a very different group of GPs work at Penryn surgery. They serve a large campus that is home to Exeter university, Falmouth university and parts of Plymouth university. There is a growing student population and the surgery has been able to expand its services to provide mental health services, prescribing services and on-campus surgeries. In attracting additional funding for services to meet the needs of the young people—we welcome them into the constituency to study there—they have additional resources from which the whole community can benefit.
	Those are two very different examples of how GPs are working positively and constructively with local commissioners to expand services, bring in additional resources and improve patient outcomes for the local community.

Roger Williams: My hon. Friend represents a very rural constituency, as I do. We do not have any single GP practices, but many of our practices have fewer than five GPs. Our experience is that when one leaves and the practice has difficulty recruiting, it really puts the practice under pressure. Can anything be done to make rural GP practice more attractive to young doctors?

Sarah Newton: That is a very good point, and I was just about to make the point that although I have given two good examples of larger GP practices that are doing very well, I also have similar issues to my hon. Friend in more sparsely populated areas of my constituency, such as the Roseland peninsula. It has an older population and it is difficult for GP practices to innovate and bring in additional services to make their future sustainable. I am in regular correspondence with NHS England, which has taken away some of the specific funding that used to be available to support remote rural GPs, in the expectation that they will be able to attract additional funding for providing additional services. That is really not possible or viable. In order to maintain access for people living in sparsely populated areas, where the population is unlikely to grow rapidly, NHS England needs to look again at funding for GP practices in such areas. I hope that my hon. Friend will make common cause with me in writing to NHS England to ask it to reconsider that point as part of its five-year plan.
	The third point I wish to make is the positive work I see at the accident and emergency department at Treliske. The Royal Cornwall hospital is the only acute hospital in Cornwall and I am proud to have it in my constituency. The head of the A and E department at Treliske has worked innovatively with his primary care partners to introduce GPs into that setting. As people arrive at the hospital, a triage system is in place so that if people would be better served by seeing a GP, they can do so, which takes pressure off the A and E department.
	Finally, I wish to share some of the learning from the integration pioneer work that is happening in Cornwall. The Government designated 14 areas of the country as pioneer areas to look at how we can better integrate care services with the NHS. GPs in Cornwall have provided an essential foundation for that work. Our pioneer bid is led by Volunteer Cornwall and Age UK Cornwall—I think it is the only voluntary sector pioneer bid in the country, and it is very much supported by the NHS right across Cornwall, and by Cornwall council.
	By working carefully with GPs to identify frail, elderly and vulnerable groups of people with chronic conditions who tend to use the NHS a great deal—GP services, care services or the acute sector—the pioneer discovered that having a trained volunteer attached to a GP surgery to work alongside families, linking up all available support and enabling them to reintegrate into the community around them, leads to a huge reduction in the use of acute and GP services, and, most importantly, significant increases in self-reported well-being.
	There are a lot of lessons that can be learnt from the reforms we have put in place. I am confident that if NHS England’s five-year programme learns the lessons from the pilots and the past five years and puts proper resources into primary care, we can see the improved health outcomes I know we all want.

Several hon. Members: rose—

Lindsay Hoyle: May I just stress that if we stick to 10 minutes, I can give everybody 10 minutes? If we run over, people will end up having their speeches cut and I do not want to do that to anybody.

Caroline Lucas: I add my congratulations to the hon. Member for Halton (Derek Twigg) on securing the debate. I am very pleased to have worked with him to have this opportunity today to discuss the vital issue of building sustainable GP services.
	Proper funding for our GP services is vital for good patient care, easing pressure on hospitals and ongoing sustainability. The question we need to ask is this: why have Ministers allowed a trend of consistently falling GP funding? The Royal College of General Practitioners made its own concern clear back in June 2013 with an urgent call for an increase in GPs’ share of the NHS budget, so that 10,000 more GPs could be hired. However, recent figures reveal funding to be at an all-time low of 8.3%, something which shows a worrying complacency. In response, more than 300,000 people, including many in my constituency, have signed the RCGP’s petition, “Put patients first: back general practice”. The petition calls for more money to be allocated to GP services.
	Alongside the campaign, the BMA has conducted clear analysis of the serious work load pressure facing GPs, an issue so many hon. Members have raised today.
	As the Minister well knows, the drop in share of the NHS budget for our doctors’ surgeries comes at a time when GPs are under increasing pressure and are having to see more and more patients. A situation in which they are seeing 40 to 60 patients a day is simply unsustainable for both patients and doctors. It is horrifying that 80% of GPs say that they do not have sufficient resources to provide high quality patient care.
	GPs in my constituency are telling me that good patient care is being destroyed because of what they see as impossible demands, including as a result of privatisation and a lack of funding for primary care services. For example, in a joint letter to me, seven local GPs said:
	“There is no doubt that general practice is really suffering from the lack of investment, impossible demands and never ending re-organisations. If we could stop having administrative battles and spend our precious hours on patient care we would all be much happier, and the service would be better and significantly cheaper to run.”

Daniel Poulter: I commend the hon. Lady for making points on behalf of her local GPs. She talked about privatisation. Would she not accept that the funding model for GPs as small businesses in their own right has existed since 1948, when Nye Bevan created the NHS?

Caroline Lucas: I accept that, of course. When I talk about privatisation, I guess what I am referring to is constant fragmentation: the way in which NHS England, CCGs and others are still struggling to get a streamlined process, which makes it more difficult for patients to be seen when they need to be seen and by the person who needs to see them.

Paul Burstow: The hon. Lady is now drawing a very important distinction between some fragmentation and fracturing in how decisions are made. That criticism has been levelled at the legislation, but it is not the same criticism she was making initially, which was about privatisation. We know that only 6% of NHS activity and expenditure goes into the private sector.

Caroline Lucas: The right hon. Gentleman is certainly right about the figures, but I would argue that the direction towards greater privatisation is adding to the problem of fragmentation. I am happy for us all to focus on the issue of fragmentation. That is the bigger point I am raising right now and it is the biggest barrier to people receiving the care they need and deserve.
	Intolerably long waiting times to see a GP have become a scandal that is putting A and E under strain and people’s health at risk. The inconvenience of increasingly unacceptable waits for an appointment will mean some people simply do not see a doctor about a persistent mouth ulcer or worsening mental health problem that they are trying to get checked, meaning that serious conditions that could be treated will be missed.
	One GP told me this week that she knew of two colleagues who are leaving to go abroad. For her, retention of GPs is a crucial problem. Female GPs in particular,
	who have children and perhaps work part time, are finding themselves having to work long into the evening and sometimes long into the night. The issue of retention is ever more pressing as more GPs retire. The current older generation of GPs is starting to do so, and getting enough young doctors to become GPs to replace them is a serious issue.

Tim Loughton: As my constituency borders the city of Brighton, some of the problems the hon. Lady recounts are similar to those in mine. I spent a lot of time with my GPs recently, sitting in GP surgeries. Does she acknowledge that part of the problem is the shortage of GPs being recruited and the heavy reliance on locums, if one can find them, which is much more expensive? GPs say to me that, despite the very best of intentions from central Government, they are still spending too much of their time filling in paperwork, chasing targets and doing admin when they should be spending that time with their patients.

Caroline Lucas: I very much agree with the hon. Gentleman and thank him for his intervention. Locums are costly and break up the continuity that so many GPs say is vital to being able to provide a good service to their patients.
	The Nuffield Trust points out that in October the proportion of GP training places left vacant rose to a historic high of one in eight. NHS England has recently made efforts to make the sector more attractive, but it faces a difficult job with an underfunded, creaking primary care service beset by constant reorganisation and the kinds of fragmentation I mentioned earlier. The Royal College of General Practitioners estimates that about 543 practices in England could face closure in the coming years as GPs retire. Hundreds of thousands of patients could be forced to seek care from other overstretched surgeries, and there is a danger that this could put even more pressure on our hospitals. That exact scenario played out recently in Brighton, with what looked like the imminent closure of Eaton Place surgery in my constituency. That would have left 5,600 patients in limbo and put serious pressure on neighbouring practices. At the very last moment a solution was found, but not before many patients had been seriously worried about the future of the surgery and had started queuing to join other surgeries further afield.
	There are serious questions to be asked about what we ask of our general practitioners and the burdens we place on them that are not directly related to patient care. Family doctors want to get to know their patients and to treat them. When I speak to GPs, the message that comes through loud and clear is that continuity is key for doctors and patients. It allows doctors to be more efficient and to get admissions to hospital right. One GP told me that doctors may be more likely to admit patients unnecessarily if they do not know them terribly well, because they do not know what their family or community support might be or how best to judge how great their needs are. On the other hand, the GP who knows their patients well is more likely to spot the early signs of psychosis in a patient who has previously never presented with mental health problems, enabling them to be admitted to hospital sooner rather than later before they have a major episode that puts them at risk.
	The Health and Social Care Act 2012 has mitigated against GPs having the time to get to know their patients. New research from the Nuffield Trust and the King’s Fund finds there has been a significant drop, from 19% in 2013 to 12% in 2014, in the numbers of GPs who report being highly engaged in the work of their CCGs. GPs do not have the time to invest in the new structure and there are now fears that the CCGs could become unsustainable. Ministers should be seriously considering how to lift unnecessary burdens from GPs instead of adding to them, so that doctors can spend their time on patient care. With more resources, general practice can keep more people out of hospital.
	I pay tribute to the innovative work on well-being that can take place when doctors have sufficient time to see their patients properly. That could genuinely transform lives. For example, in my constituency a GP told me how, after getting to know her patient well, she prescribed a dog to a man who was depressed after a heart attack. That might sound funny, but it was a simple solution that worked: it was more sustainable, made him much less socially isolated and provided him with regular exercise. Another example of innovative work in my constituency is the homeless health care project. It is incredibly impressive. It works solely with homeless people and people in insecure accommodation—for example, people in hostels or who do not have a permanent address—but it needs a more flexible funding formula to extend its groundbreaking work.
	That kind of work captures where the health service needs to be going. The current system was designed for acute infectious diseases, which were a 20th century phenomenon. The current phenomenon is of chronic, complex, multi-morbidities with poly-pharmacy. The trusted family doctor who can spend time with an elderly patient with three long-term conditions and 12 different medications and who brings his wife in to discuss his care is not only providing a good, thorough and caring service, but saving the NHS money; helping to make it more sustainable; preventing the crisis by focusing on their physical, psychological and social needs; and treating them as a family and members of the community.
	The local GP who gave me that example is meant to have that elderly couple dealt with and written up in her notes in fewer than 15 minutes—and she is lucky because most GPs are given only 10 minutes. Her practice decided that 15-minute appointments were more efficient, because allowing more time kept more people well, but the system will not cope if there are not enough hours in the day and not enough GPs doing that work. The kindness that is shown by giving longer appointments to prevent the elderly man and his wife having to come back another time to discuss the different chronic conditions comes out of lunch breaks and evenings. The part-time GPs with kids give a lot in this system, and they are not going to stay if things do not get better.
	I want to reiterate the importance of celebrating what happens in our NHS today, in spite of the conditions faced by some people. It is essential that we increase GP funding.

Paul Burstow: I thank the hon. Member for Halton (Derek Twigg) for securing this debate. My name was on the application, but he
	was the person who made the argument that persuaded the Backbench Business Committee. I apologise to him for not being here for his opening remarks or for those of others who have contributed so far.
	I was keen to contribute to the debate because it goes to the heart of how we make the NHS fit for the future and do more in the community. As the hon. Member for Brighton, Pavilion (Caroline Lucas) said in her closing remarks, the focus has moved from treating episodes of ill health and diseases of individual body parts to people living with a complex range of diseases. It is that complex co-morbidity that is driving the need to change how health care is organised and delivered in this country. If that does not happen, the system will become unsustainable. At the heart of that is the family doctor and their relationship with their patients and communities, which is a key component of building the system we need for the future.
	About two months ago, I and my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) met a group of GPs in my constituency to discuss some of the issues being aired today—Dr Chris Elliott, Dr Brendan Hudson, Dr Alan Froley and Dr Mark Wells—along with a practice nurse. I was pleased that a practice nurse was present, because although we are discussing the sustainability of GP practices, we need to recognise, as I am sure others have, that we are talking about the wider primary care family and the contribution made by many other professionals. We discussed the pressures on practices in our constituencies. The demands have been well documented, but I want to rehearse a couple. One frustration—it has long existed, but some of the GPs felt it had got worse—concerns the expectations around paperwork and reporting, which they feel have now got out of control. That needs to be kept under review and, where possible, streamlined. I hope the Minister will say something about that.
	According to data available at CCG level on the performance of primary care and, in particular, access to GPs, in my patch, Sutton scores above average when it comes to getting an appointment, which is good news, but once someone has an appointment and arrives at the surgery, it turns out they have to wait longer than average to actually see their GP. So they can get there, but then have to wait far longer than is acceptable, and often in substandard accommodation. My constituency is a suburban part of Greater London and most of its GP practices are situated in larger houses that cannot accommodate the 21st century primary care we need. We need the investment from the infrastructure fund to flow through and allow for innovation.

Daniel Poulter: I thank my right hon. Friend for his point about the money from the Government for GP infrastructure, but is there not also a responsibility on local authorities, when there is additional house building, to look at the contribution developers can make to support local GP and health services by developing GP and other community health care facilities?

Paul Burstow: Absolutely, and certainly in its local planning my local authority does exactly that—it looks at what the community facility needs are. In the southern part of my constituency, in south Sutton, there has been some controversy over plans for a new GP centre. It is planned on a piece of land that was NHS land but
	which does not sit within easy reach of public transport and is perceived to be in the wrong place. It is also less than a mile from a soon-to-be-unused hospital site that many of my constituents feel would be a more sensible location. It will be the basis of a new housing development in the coming years and so will be the perfect place for a consolidation of existing substandard GP surgeries currently based in houses.
	In its briefing, the Royal College of General Practitioners has set out some of the pressures on GPs, including increased levels of stress and depression. In a ComRes poll it conducted, eight out of 10 GPs expressed concern that those pressures were leading to an increased risk of misdiagnosis. Yesterday was world cancer day but there are still serious issues with the number of people who do not get a cancer diagnosis until they are in an accident and emergency department, by which point it is far too late, and consequently, their lives are cut short.
	GPs are at the heart of delivering health care: nine out of 10 NHS consultations take place in a GP surgery, while the number of consultations has increased by 40 million since 2008 to 340 million. Interestingly, according to the 2012 GP patient survey, 1.2% of patients went to a walk-in centre or A and E department because they could not get a GP appointment at a time that worked for them, but that figure has now risen to 1.7%. I am sure the Minister will tell us that those are very low percentages and therefore not a cause for concern, but given the number of consultations—340 million—it does not take a very high percentage to have a significant impact on our A and E departments. Given that there are nearly 14.6 million A and E attendances, we can see that the gearing is such that ensuring sustainable and easily accessible GP and primary care services is critical to getting the balance in the system right.
	I hope the Minister will say something about the piloting of 24/7 access to GPs and ensuring we have the right data to better understand which areas are under-doctored so that we do not have to rely on anecdotal evidence. There is clearly a concern about deprived and rural areas not having sufficient doctor cover, but at the moment we cannot map that accurately. I hope he can tell us what is being done to target resources to support areas crying out for better GP coverage. In addition, I hope he can say what will be done to address the fact that, despite the Government’s having identified the need to train more GPs and despite the number of places having increased significantly under this Administration, not enough places are being filled. What is being done to get up to the right number?

Annette Brooke: I have visited a number of GP practices and I agree that while they are desperately trying to meet the increased demands, the frustration at not being able to recruit is adding seriously to their stresses and strains.

Paul Burstow: It is said that we need about half of all trainees to go into general practice and, at the moment, only 2,700 of the more than 3,250 places that are available are being filled. That is an issue, but it sits in the context of a global workforce pressure when it comes to medical staff. The opportunity to fill this gap by recruitment overseas will be difficult as well.
	I am conscious that others wish to speak so I shall end by asking the Minister to address the issues of access, of how we make sure that more deprived areas do not suffer a double disadvantage by not having access to good quality primary care and of what will be done to ensure that we cease to have this distortion of funding priorities caused by a payment-for-activity system in our acute sector and a contracting model for primary care that has disadvantaged primary care for too long and led to this reduction in funding that other hon. Members have talked about. I look forward to the rest of the debate and the Minister’s response.

Natascha Engel: It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow) who, in his previous role as Minister responsible in this area, gained a wealth of knowledge of primary care, mental health and social care, something I want to pick up on in terms of GP services.
	I do not want to repeat everything that has been said before, but without a doubt GP services are facing a real crisis. Everybody has mentioned how many people use their GPs. Most people have a GP. Over 90% of all contacts made in the NHS are made through GP services. GPs and GP practices are the absolute bedrock on which the NHS is founded, so we must get this right. At the moment something is going very, very wrong.
	I want to put this in context. The hon. Member for Clacton (Douglas Carswell) said earlier that this was about patients, not doctors. Unless we get right the framework in which the doctors are working, it is the patients who suffer. We also need to understand that, over the last 20 years, the number of GP consultations has risen by 25%. There are many more appointments, without the system having changed that much to accommodate that. The average person now sees a GP six times a year, which is double what it was a decade ago, but the word “average” hides something. I represent a constituency with quite high levels of deprivation, but there are a couple of perfectly well-to-do areas where the GP services are not in crisis and are absolutely fine. The problems are in those areas of greatest deprivation. Arguably those are the areas that most need GP services to be running as well as they can. It is also where GPs are under such a lot of strain; some are retiring early and others are not going into GP practice in the first place. I want to emphasise that if a person is deprived, they will use their GP services as much more of a lifeline than others who go to see their GP.
	My hon. Friend the Member for Walthamstow (Stella Creasy) spoke passionately on behalf of her constituents. We found in one of our practices where services were starting to crumble that problems compounded each other. Once things start to go wrong, there is a terrible domino effect. A high number of patients are signed up to my practice and one of the partners retired. That one retirement caused the GP practice to go into crisis. We can all sometimes make the situation worse by highlighting an individual practice, in order to try to help as much as possible, and saying that it is in crisis. That means that GPs will not then apply to work there, when actually the issue is not about that one practice; it is one piece of an entire jigsaw. Patients then leave that practice and sign up at a neighbouring practice, causing that practice to
	go into crisis. We need to look at this not from the perspective of North East Derbyshire or Walthamstow, but as a national problem.

Jamie Reed: Does my hon. Friend share my concern that unless we as a country address these problems quickly, holistically and in a detailed way, we run the risk of creating a two-tier NHS service, in which those who, as she rightly points out, most need care are less able to access it?

Natascha Engel: Absolutely. I am deeply concerned about that, and about where the pots of money are that people are accessing. I will come to that in a moment. One thing I hear a lot locally is, “The problem is that we are all living longer.” Of course it is not a problem that we are living longer; it is fantastic, but we need to change the way we look after people as they get older. The problem is not just dementia, cancer or heart disease; diabetes, as we have heard, is an absolute killer. We need to invest much earlier to make sure that people can manage their illnesses or, hopefully, avoid them altogether. GPs have a fundamental role in that.
	What I really wanted to talk about was the interconnection locally. We have had enormous cuts to the budgets of local authorities. Derbyshire county council, which is responsible for social care, has had its budget slashed to a point where it is difficult to provide the levels of care that were provided before. I have a sheltered housing facility called Mallard Court, where 50 people are living independently because they have a warden service. That warden service and the care line allow people to live active, social and healthy lives with a minimum level of support. Cuts to local authority funding mean that that social care can no longer be provided. We are looking at finding other ways to provide it, but taking that warden away means that those people will, in a matter of weeks or months, go into crisis, whereas now they are living independent lives. In looking at GP services, we need to look at that issue as well, as it is the local GP practices who will feel all the pressure of those 50 individuals.
	That goes back to my point about pots of money and the ring-fencing of them. We can have social services, GP services and acute care in different places, which sucks up all the money in the NHS. Unless we start to look at all of this, as my hon. Friend the Member for Copeland (Mr Reed) said, as one big picture, the solutions will not be found.
	Younger generations are much more demanding, and people have access to the internet. It is good that people are more demanding. That gives a rocket boost to the NHS by making people develop and keeping them on their toes, but we really need to make sure that people are realistic in their demands. The group of practice managers that I meet regularly—they have joined us here today—would say that it is a question of people being realistic in the demands they make on GP services. As MPs, we need to promote that.
	I want to talk about normal GP practices. Most of my practices have multiple members. At the moment, there is immense stress and strain on GPs who are partners and own the building that the practice is in. Those employed just as GPs in the practices do not have the same pressure, financial uncertainty and risk that a partner does.
	What often happens is that partners retire young and sell their shares in the ownership of the practice. People are not taking on that risk, but are instead working, often in the same practice, as locums. As locums, they can earn around £100 an hour, and that is before they start charging for additional things on top. Rather than having all that stress and strain, and never really having the time to take a step back and look at the bigger picture of where the GP practice is going, partners are standing down and working as a locum, doing the work that they want to do and getting highly paid for it; that is, so far as I can see, a no-brainer.

Tim Loughton: The hon. Lady makes a very good point. I, too, mentioned locums. Are not the pressures on and requirements of partnered GPs deterring many people? That is why it is easier for Worthing hospital to recruit doctors; it is looking to take on directly salaried GPs to place in the A and E department to relieve pressures there.

Natascha Engel: Absolutely, and we ought to look at the issue of ownership of GP practices quite quickly; perhaps more imaginative ways can be found of ensuring that NHS England and those in the areas finding things most difficult can take on ownership of individual practices and GP services. We need to consider all these different issues. The Royal College of General Practitioners has said that there is a shortage of 10,000 GPs, and we need to get on top of that urgently. We need to make it more attractive for GPs to go into practice. As the hon. Member for Clacton (Douglas Carswell) said, it is patients who suffer when there are not enough GPs in the service.
	I have worked closely with Steve Lloyd, a GP who is chair of the Hardwick clinical commissioning group, which covers the southern part of my constituency. He took me through all the facts and figures, but the big point he made at the end was, “Cherish it or lose it.” I want to end on that note.

Anne-Marie Morris: There is absolutely no question but that we all have a huge respect and admiration for our general practitioners. They do a fantastic job, and I am immensely proud of our GPs in Devon. Indeed, my GPs do the out-of-hours services themselves; they created “Devon Doctors”. Although it is accessed through the 111 service, we all love it because we see it as our doctors.
	It is unquestionable that GP services are currently challenged—in large part because there has been an awful lot of change. As previous speakers have commented, there are simply more people; we are building more houses; there are more homes. Although being able to live longer is a wonderful benefit, the fact that we have more elderly individuals with more complex needs puts a different level of pressure on GPs trying to deal with this challenge.
	The issue of GP numbers is a complex problem. The issue involves training places, attracting people and a whole range of other things. As others have dealt with the matter very competently, my comments will not focus on that particular challenge, but I would reiterate some of the comments made by the hon. Member for North East Derbyshire (Natascha Engel) about the challenges of keeping partners and passing partnerships on to the next generation. The hon. Lady was right that
	the burden of paperwork and bureaucracy acts as a deterrent, and that being a locum provides a much easier lifestyle.
	Capital cost is a major issue. I understand that in the old days a loan could be acquired through the primary care trusts—not directly, but there were schemes to enable people to buy into a practice so that the partner could retire—but that that option is no longer there. That shows that there are problems beyond the bureaucracy and red tape—particularly about financing the challenge of GP numbers.
	One of my greatest concerns is about rural and deprived communities. I would like the Minister to undertake a proper analysis of where those deprived and those rural communities are. I am absolutely convinced that it is possible to work out what is where, and consider the quality and adequacy of the GP services within those different areas. We need to unpick the problems before we can ever find solutions.
	I believe that we need a new model. This has been talked about for many years and under a number of Governments, but I am hopeful that, under Simon Stevens’s leadership, we will come up with something fit for purpose, on which all parties can agree. He is already indicating some changes. I would certainly not advocate another major reorganisation, but he is looking sensibly at the use of GPs in hospitals and similar issues. As I say, we need a new model.
	Clearly, we need to consider the possibilities for integrating within primary care and across primary and secondary care. I do not believe in a one size fits all, but we need to look at a variety of models. I am pleased that in my local community, whether it be NHS, social care, the third sector or indeed the private sector, they are all working together to give the quality of care that constituents need. That is greatly to their credit.
	I am pleased, too, that in Newton Abbott we have had funding from a pot of £3.5 million for a pilot scheme on dealing with the frail and elderly. It deals with how to look across the spectrum to ensure that these individuals can with the right sort of support stay for longer in their own homes, which is clearly better for them as well as reducing pressures on A and E. I very much look forward to seeing the results from that.
	The overall model needs to take integration into account, because for too long primary and secondary have been seen as separate sectors, never mind their separation from social care. We need to look, too, at a new physical model. We talk about public health—a responsibility now given to our county councils or unitary authorities—and we need to consider what we can do to keep people healthy and fit. The concept of a hub is important, where medical care and social care, perhaps along with a gym, could be provided. We need something to pull all those things together—a way forward in some areas. I would like to think that that could be a practical solution in one of my towns such as Kingsteignton. It is challenging to find somewhere for a new GP practice: one integrated in that way would enable us to support the serious funding challenges . I would love to think that NHS England has limitless pots, but that is simply not true. That is why we need to involve the private sector—providing the gym or other attribute—in making the new hubs work.
	We also need to look at non-physical structure, by which I mean telemedicine. A particular challenge for rural communities is how to use telemedicine more effectively. That could be an additional challenge, of course, because it depends on whether we have the internet and whether individuals know how to use it. It is a challenge that we need to take seriously none the less. We must be careful to ensure that we do not say, “If you live in a rural community, you can have just telemedicine”. That would be a great mistake. One of the greatest fears of my local rural community is that as it becomes more sparsely populated and people become older, they will effectively be forgotten. That would be absolutely wrong. Telemedicine has a place, but it cannot be the only solution.
	The main challenge is to meet the need for a long-term plan. I hope the Minister will tell me that he and NHS England have a vision of how to deal with—or at least look at—urban and rural issues, how to deal with deprived and less deprived communities, how to deal with the physical versus the non-physical solution and how to deal with the issue of integration versus stand-alone. We must ensure that we have space and place for the new solutions and the new models.
	One of my deepest frustrations is that a good local authority will take into account the housing numbers and the need for a new hospital or a new GP surgery, but because the NHS is not a statutory consultee of the planning process, it is not properly thought through. The challenge is to get the NHS involved. The average GP and indeed the CCG have enough on their plate without getting involved in planning issues. That said, it is crucial for us to get this right, because otherwise we shall be landed with huge challenges. New homes will be built, and there will be no local GP services. Our local plan for Kingsteignton, which was completed recently, provides for a substantial number of new houses, but does not reflect the clear need for additional general practices. We need to find, somewhere in the area, a new space and a new place.
	When it comes to planning applications, the NHS is—again—not a statutory consultee, and therefore faces considerable challenges. The number of houses involved in an application can suddenly start to increase exponentially. In the north of my constituency, in the Dawlish and Starcross area, we were to have 1,000 new houses; now we are to have more than 2,000. The local general practices are very worried about how they will cope. Having looked at their existing sites to see how they can develop them, they apply to the council for planning permission, and they cannot get it. They are feeling incredibly frustrated, because they want to provide a service, but there is absolutely no way in which they can do so.
	In the case of a development in Newton Abbot, a surgery has relocated, which is great—the accommodation is much better and more fit for purpose—but the issue of bus services has been overlooked, and many people have complained to me that it has not been thought through. That is partly because the NHS has simply not been involved, in any guise.
	Local residents are deeply concerned about the changes, and I am regularly approached by patient groups who say, “What are we going to do? We absolutely need to support our local communities, but we cannot see a way forward. We face challenges because existing practices
	cannot expand, because we need funds so that new partners can replace those who wish to retire, and because the grand plan has not been thought through and our local NHS body has run out of money.” Although the financial year has not yet ended, there is no money, and if we are to have a new general practice, we must find another way of securing that money.
	There is a huge fear that if the Government cannot come up with a better way of dealing with those challenges, large private organisations such as Boots will suddenly become the new general practices. Boots currently provides flu vaccinations and the like, but it is clear that it is only one step away from starting to look into how it could provide GP services alongside a supermarket or health hub. Access is obviously important, but the fear is that people in rural areas and the elderly who cannot get to Boots will not receive those services.
	We need a plan, and that plan needs to be articulated. We must have a strategy to establish how we are to plan for all this—“plan” as in “planning”—and patients and residents must be involved in the decisions. At present, they feel that they are out of the loop. There is a real fear among rural and elderly communities that they will lose out, and we absolutely must ensure that that does not happen.

George Howarth: Let me begin by congratulating my hon. Friend the Member for Halton (Derek Twigg), first on securing the debate—with the agreement of the Backbench Business Committee—and secondly on the typically well-argued way in which he put his case. I agree with every word that he said about the problems, both local and national, that have resulted from the reorganisation and the policies that the Government have pursued since 2010.
	I want to draw attention to problems in two general practices in my constituency, particularly in respect of the buildings in which they are housed. I should mention that they are used both by my constituents and by those of my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg). I know that my hon. Friend wanted to be present, but he is having to perform other duties elsewhere in the House.
	The two general practices, which I visited last October, are the Roby medical centre and the Pilch Lane surgery. About five years ago, the primary care trust acquired a site close to four surgeries which it originally planned to move into new purpose-built premises. Unfortunately, the development did not go ahead, for two reasons. First, the proposals were caught up in the abolition of the PCT and its replacement by a clinical commissioning group. Secondly, there were some problems with the lease on the premises where one of the practices is currently housed, as a result of which the PCT could not contemplate proceeding with the move. However, both practices are still keen for it to go ahead, and they have the strong support of the CCG: it hopes to develop the site, which is conveniently placed near the existing surgeries.
	Let me say a little about those two surgeries. The Roby medical centre has about 1,900 patients, and, because of local housing development, is still growing on an almost daily basis. As well as providing the normal GP services that we all expect, it is involved in
	the teaching of medical students, and is working towards becoming a training practice. It already provides a wide range of services, but would like to provide quite a few more if it had more suitable premises. Obviously, some of the pressure on hospital services would be removed if patients could visit their GPs instead.
	The building itself consists of two converted semi-detached houses. It lacks consulting rooms, and the waiting area is restricted, with the inevitable result that patient confidentiality suffers. Some of the staff are housed in a totally inadequate conservatory which is tacked on to the back of the premises. It is clearly not suitable for the staff, and certainly not suitable for the patients. Because of the size restrictions, it is impossible to conduct two surgery sessions at the same time. There is not enough space to accommodate the patients, or to allow movement from the waiting area to a consulting room. Moreover, very little parking is available.
	The Pilch Lane surgery has 4,700 patients. Like the Roby centre, it is very successful in that regard. However, it does not meet the current NHS dimension criteria. The toilets are inadequate, one treatment room doubles as a consulting room, and access for disabled patients is almost non-existent. The building is, in fact, wholly inadequate for the needs of both the patients and the people who work there. Earlier today I talked to one of the patients, who, by coincidence, had had an appointment at the surgery yesterday evening in connection with a minor problem. She summed up the position by saying that, although the service that she had received from medical and other staff had been exemplary, the building was simply not equipped to provide the sort of service that we should expect in the 21st century.
	In December, I wrote to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), to put all the arguments to him. He will be aware of the problems I have referred to; if he refers back to the correspondence, he will recognise some of the problems I am concerned about. In January I received a response from his ministerial colleague, Earl Howe, which was quite interesting. He basically said that he could not intervene and that there was no action he could take. He concluded with a rather odd use of words; he said that he could not be directly helpful, for which he apologised. The reason he could not be directly helpful is that Ministers have absented themselves from the process and left it to others. I am interested in whether, if Earl Howe could not be directly helpful, the Under-Secretary of State could be indirectly helpful, because this situation cannot be allowed to continue.
	I do not want to detain the House any longer. There is a real problem for patients and for the staff in the two surgeries concerned. That problem has been recognised by the CCG—the chair and excellent chief executive have recognised it. I hope that Ministers will use whatever influence they have, whether direct or indirect, to ensure that this long-standing problem is resolved as quickly as possible.

Jim Fitzpatrick: It is pleasure to follow my right hon. Friend the Member for Knowsley (Mr Howarth). I congratulate my hon. Friend the Member for Halton (Derek Twigg) and his supporters on securing this important debate.
	I first raised this question on behalf of GP practices in Poplar and Limehouse on 13 May last year and the issue has not gone away, as the Minister is aware. The motion states that the House
	“notes the vital role played by local GP services in communities”.
	I am sure that we all feel that we do more than note those services—we are very appreciative of them, we value them and have high regard for them. Doctors at the Ettrick Street practice on the Aberfeldy estate in east London, especially Dr Phillip Bennett-Richards, do a first-class job for us and are highly regarded by the local community.
	I was grateful last year when the Minister’s colleague, Earl Howe, agreed to meet me and a small delegation from two practices in my constituency.

George Howarth: Earl Howe refused to meet me to discuss the problem I described earlier, which is an unusual thing for a Minister to do.

Jim Fitzpatrick: I am surprised that the Minister declined to meet my right hon. Friend. The Minister certainly showed me every courtesy and I was grateful for the opportunity to meet him, his officials and officials from NHS England. As a result of that meeting, we identified solutions for both the Jubilee Street practice and the St Katharine’s Docks practice, which were under severe pressure at that time. Indeed last Friday, I had the pleasure of attending the opening of the refurbished St Katharine’s Docks practice, which is run by Dr Sarit Patel. I pay tribute to Ms Sue Hughes and the Friends of St Katharine’s Docks for the central role they played in supporting their local GP and his practice. The Jubilee Street campaign, also supported by its local community, was also effective.
	Now we have a borough-wide save our surgeries campaign, with banners across Tower Hamlets outside every GP practice. The Jubilee Street and St Katharine’s Docks practices have solutions, but they are not permanent. On Tuesday, I received an e-mail from Sue Hughes. She reports, among many other matters, that
	“Dr Patel has found it impossible to have a meaningful dialogue with our local representative of NHS England to discuss in detail the future funding of the Practice. NHS England insist on using one size fits all formulas to calculate additional financial support for GP Practices which clearly have differing requirements. NHS England are not paying the Practice for work they already do over technicalities which NHS England refuse to discuss with them. NHS England disregard ‘quality of outcomes’ when deciding on funding formulas—why is this?”
	Having received that e-mail, I wrote to the Minister and I look forward to a response in due course.
	The Limehouse practice in Gill street is also struggling to secure its future and is under great threat. I have written separately to the Minister on the Limehouse practice. Oher GP practices are under huge pressure. In addition, there is the worry over the future of the walk-in centres at the St Andrews and the Barkantine health centres.
	I wrote to the Department of Health about Barkantine because it combines a walk-in centre with a 10-handed GP practice and as a result is able to offer 8 am to 8pm, seven-day-a-week services to patients, which are under threat. The Prime Minister announced some time ago
	that the Government were going to spend significant sums trialling 8 am to 8pm, seven-day-a-week services, but there was not any need. The Department could have easily sent officials to east London and we could have shown them how such services can operate efficiently and effectively. However, that is all under threat.
	During recent years, when the PCT was in charge, we had the fastest improving GP services in the country. The CCG has done excellent work and is staffed by first-class people. It is doing all it can to assist but we need NHS England and NHS England London to provide reassurances that all will be well.
	Yesterday I received this e-mail in response to my correspondence on the walk-in centres—I thank my hon. Friend the Member for Halton for securing this debate because it is a great coincidence that the e-mail arrived the day before it. The response from the Department of Health is efficient and I am grateful for it. It has some good news. It says:
	“NHS England have agreed to extend the existing break clause”—
	this is in relation to the walk-in centres—
	“in each of these two contracts by 9 months moving this date from 30th September 2015 to 30th June 2016.
	Tower Hamlets CCG has applied to become the commissioner of primary care services under delegated approval arrangements from NHS England. If approved, this will become effective from 1 April 2015 and this will become a matter solely for the CCG.”
	That is good news as it lifts the immediate threat to the walk-in centres, but it is not a permanent solution; it is a temporary reprieve. However, this is clearly new, certainly to me, and shifts the focus from the Department of Health and NHS England to the local CCG, which I hope will be able to fund the right decisions for local residents on a permanent basis.
	On the temporary solution for the Jubilee Street practice, the practice manager, Virginia Patania, reports that meetings have been held with Department of Health officials, including Simon Stevens. She says that there should be protections for
	“practices whose MPIG”—
	the minimum practice income guarantee—
	“has been removed”,
	and that
	“NHSE is completely ignoring the issue of cumulative losses. In any reply to our challenges to NHSE, there is no mention of the cumulative effect of losses—this has not been addressed by NHSE in any correspondence or response. It is unfathomable to us that NHSE is not or cannot be held to account for having only looked at 25%...of overall losses and estimating these as final.”
	She concludes that
	“we can demonstrate that populations of the most deprived adults attend GP surgeries up to twice as often as populations of the country’s wealthiest adults. This makes the Carr Hill formula entirely inadequate for areas such as Tower Hamlets”.
	Tower Hamlets GPs have offered solutions and we have asked for another meeting with Earl Howe. I hope that we will be successful in that.
	Like other colleagues, I have received briefings from the BMA, the RCGP and Londonwide LMCs. What is significant are the stats they all have in common, which my hon. Friend the Member for Halton and others have mentioned. Only 8.3% of the overall NHS budget goes to GPs but they are dealing with 90% of patient contacts. The royal college has estimated that at least 500 practices are at risk of closure and that nationally we need to
	recruit 10,000 more GPs, which has also been mentioned. I got a sticker from Londonwide LMCs this morning saying, “I love my GP.” I refer to it cautiously because I do not want to suggest that I am trying to have a relationship with my GP, no matter how much respect I have for him. Everybody does love their local GP, however, on the basis of the service we receive in east London.
	The most threatened practice in Poplar and Limehouse is Limehouse. I have mentioned that I have written in detail about its problems, and I would appreciate a response. There has been extensive contact with NHS England and between NHS England and the practice manager Mr Warwick Young on the minimum practice income guarantee, the quality and outcomes framework and other issues. It is looking like it will lose more than £600,000 over the next seven years. That makes a great deal of difference and the practice could close.
	Last year I began my remarks by saying the debate I had asked for was about three things. The first was to find out the nature of the problems facing GP services. The second was to determine whether the Government accepted there was a problem. The third was, hopefully, to identify a solution. We are still looking at the problem. The Government seem to accept that there is a problem and are trying to find solutions, but they have only been partly addressed and not resolved. There is still great concern not only among clinicians and staff, but among patients and residents in Tower Hamlets, that their GP services are not safe.
	I know the Government have their five-year forward review and their focus on giving GPs a more central role. I look forward to hearing more about that from the Minister in due course, but the issues are not resolved, and I would be grateful if he would take back my request to Earl Howe for a meeting with him, or at least with his officials, on the three main practices I have mentioned and collectively on GP services in Tower Hamlets.

Mark Reckless: I thought that GPs had it rather good after their new 2004 contract. They were able to give up out-of-hours care on attractive terms, they saw their pay go up, and there was a system of quality and outcomes framework points which saw many GPs and practices move towards the maximum numbers quite quickly in what seemed to be more of a box-ticking exercise than had been anticipated, and for which there was further income.
	However, the more I have looked at this and the more I have spoken to GPs in recent years, the more sympathetic I have become in relation to the pressures under which they operate. There clearly has been a great increase in demand for GP services. There is not agreement on the causes of that or on the importance of various factors, but several factors clearly have played a part. One of them is our population rising by close to 4 million in a decade. A significant part of that is due to immigration, and some is due to natural increase. The population is also ageing, which drives greater demand.
	I am also concerned about the change from NHS Direct to the 111 service. I do not pretend to be an expert on this and to be able to give a definitive view, but there is at least some evidence to suggest that the
	111 service with untrained staff, or at least not qualified nurses, taking calls has a significantly greater tendency to err on the side of sending people to their GP than the NHS Direct service did, and that that has been at least a partial cause of the increase in NHS demand.
	There is great variety in how often people go to their GP. I am not a regular attender, although I have two young children and lean more towards going—and certainly taking them—than I did in the past. I think people generally come to fairly sensible judgments as to when they need to see their GP and when they can deal with a situation themselves or by visiting a pharmacy. I am not sure it is helpful to have a 111 system that leans so far in favour of being on the safe side and recommending people go to their GP. Clearly the 111 operators and the people running that service do not want to be blamed if someone is not sent to a GP or for medical intervention when they need it. On the other hand, they need to understand that if large numbers of people are sent on to those services when they do not strictly need to be, that will mean others do not get appointments and might not get the treatment they need.
	Medway has seen significant population growth. We have particular challenges, but I am extremely impressed with our CCG and in particular Dr Peter Green and Dr Nathan Nathan who lead it. They have a go-ahead, ambitious attitude to what they can do both in their commissioning generally within the health service and now in the very positive approach of co-commissioning with GP surgeries, with GPs in the lead. They know best, and it is a very good basis for making commissioning decisions. I recognise the potential conflict of interest GPs have in commissioning for GP surgeries, but it is good to lean more in favour of having services provided in GP surgeries rather than in hospitals. That can be a positive thing, and I hope the three different models and working with NHS England will be a success in getting the right trade-off in this area.
	Medway wants to attract and retain more GPs. That involves in part promoting Medway as a place and showing the opportunities it offers, such as relatively good value housing for somewhere as accessible to London, and a very good and improving living environment in both our rural and urban areas. I had the opportunity myself recently to attract quite a lot of publicity to the constituency and in particular to Rochester, which I hope will be to the good.
	We must also deal with the large number of single-handed GPs. Some of them deliver very good care, and there are one or two who, in a self-deprecating way, may say there is a reason why they are single-handed when they are pressed to do things differently. Of course, single-handed GPs have a place in our system, but I believe it will be good if we can persuade larger numbers of these single-handed practices, even some of the smaller ones, to work more closely and to amalgamate. They could share the fixed costs, do less administration and be able to see more patients, or even have more time off in some cases.
	It is also key to show that GPs in Medway are doing extra and interesting things. I am particularly impressed by the work that has recently been done on familial hypercholesterolemia. I am interested in that because there has been a collaboration between Medway GPs and the charity Heart UK, which was co-founded by my father. I understand that there is shortly to be a
	study of the success of this programme in Medway in the
	British Medical Journal
	. That could be an example to other areas. This work has been able to identify hypercholesterolemia not in one in 750 people as before, or in the one in 500 that was suggested may be the rate across the country, but in close to one in 350. By identifying those who suffer from that condition, we can put in place preventive measures to improve health and prevent heart attacks as well as other negative medical developments. The GPs in Medway should be congratulated on this groundbreaking project, of which I am very proud.
	Finally, on the difficulties in getting appointments at our GP surgeries, I recognise that there is no perfect appointment system that everyone will be happy with, but we have a particular challenge in the rural part of the Hoo peninsula. The Elms medical practice has its main centre in Hoo and outposts around the peninsula. I recently talked to people in Allhallows, which is perhaps 10 miles from Strood, and Grain, which is 13 miles away from other care and facilities. There used to be two GP medical practices in Grain, but now there is just one. I understand that it is open only between 9 am and 11 am three days a week, although some people in the village say it may not even always be available during those hours—but I would like to speak to the Elms medical practice before saying anything definitive on that. Similarly, I have spoken to many people on the doorstep in Allhallows and although many are satisfied with their GP services, there is a perception that they are not available for as many hours during the week as they should be, and that one day or morning may be set aside for training at certain times. Again, I will check whether that is correct. People in those areas feel under-served. We have talked about a great increase in demand for GPs, but I am not sure that the supply has responded, at least in these rural areas, where there clearly is a need for greater GP services.
	In two practices in Rochester people have faced problems with the booking system. At one, people are not allowed to book in advance by telephone or they find it difficult to get through—a lot of hon. Members will be aware of similar stories. This practice then allows people who come in person and queue up outside to jump the queue of people who are telephoning in. I have seen a large number of elderly and often ill people queuing, before 7.30 am in some cases, to try to get an appointment. That cannot be right and I hope we can find ways of ensuring that people do not have to do that.
	At another practice in Rochester a lady called up on 30 January to ask for an appointment only to find that the first one that can be offered to her is on 16 March. Waiting for more than six weeks for a GP appointment cannot be right. I am also told that people who book online have preference, and people such as this lady, who do not have internet access, are clearly at a disadvantage. It is also difficult to get through to the telephone booking system, and then it has eight options and only when someone gets through to option 8 are they even allowed to start making an appointment. I recognise that there is no perfect system, but I hope to work with these surgeries to improve their accessibility to the public. I would also like to thank all the GPs and those who work with them in Medway for the work that they do.

Grahame Morris: I congratulate my hon. Friend the Member for Halton (Derek Twigg) and the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing the debate, and all those right hon. and hon. Members who supported the bid to the Backbench Business Committee, and the Committee itself, on accommodating the debate.
	It has been said before that when someone is the last person to speak in a long debate they find that perhaps everything has been said—but not everything has been said today. I will try not to repeat the arguments that have been rehearsed, but I wish to air two specific points that have not been covered. One is about the importance of GP work force planning, and the other is about the north-south divide and the need to refine our recruitment to address inequalities in areas of particular need.
	We must accept, although Government Members are reluctant to do so, that we have a crisis on the front line—primary care and GP services are the first line of our NHS. I do not want to apportion blame—I can see the Minister staring at the heavens thinking, “Here we go again”—because I will let others do that. However, I wish to identify some problems and propose some practical solutions to address this crisis, because we face an unprecedented health challenge and it certainly has a bearing on what is happening elsewhere in the health service, particularly in accident and emergency.
	We are all aware now, because it has been repeated many times, that we have an ageing population; people are living longer, and they are living with multiple and much more complex long-term conditions. Numbers have been given on the rapid increase even between 2008 and 2018, when we estimate that the number of people living with multiple long-term conditions will rise from 1.9 million to 2.9 million. Dramatic projections are made about the numbers of people who will have dementia, who will be living with cancer—surviving it and living beyond that—who will have diabetes, and who will have heart disease. Despite the increase in the age of the population and rising demand, GP numbers have not kept pace with population growth and with this increase in demand.
	As today’s motion states, local GP services play a “vital role” in our communities, with 1 million patients every day receiving care from their family doctor or a nurse based in a GP practice. Many Members have mentioned being contacted by the Royal College of General Practitioners about its Put Patients First campaign, which highlights some alarming statistics: as many as 90% of doctors are saying that general practice does not have sufficient resources to cope; and spending on GP services as a share of the NHS budget has been falling and, at 8.3%, is at an all-time low. Surveys carried out by the BMA have been showing that six out of 10 GPs were considering taking early retirement because of the stress of an increasing work load, with a third of them actively planning for their retirement.
	The problem we face relates not only to early retirement, but to retention and recruitment. A large number of GP trainee vacancies are unfilled and there is a stark north-south divide; almost all trainee posts were filled in the south, but in my region of the north-east—an area with the highest levels of deprivation and health inequality, where
	there is already an acute shortage of GPs—30% of training places were unfilled. That was confirmed by the deputy chair of the BMA, Richard Vautrey, who said:
	“These figures are deeply concerning and represent a serious threat to the delivery of effective GP services to patients.
	They show that we are experiencing serious shortfalls in the number of doctors choosing to train to become GPs, which will ultimately mean fewer GPs entering the workforce across large parts of the UK, most worryingly in already under-doctored areas such as the North”—
	including the north-east—
	“and the Midlands.”
	We need to address the imbalance in posts between the north and the south, because if we do not, as my hon. Friend the Member for Copeland (Mr Reed) indicated from the Front Bench, we will see a division in the standard of care. There is always a risk of this in different parts of the country.
	I also recommend the “Securing the Future GP Workforce: Delivering the Mandate on GP Expansion” report by Health Education England. It states:
	“There is a variation in availability of GPs of more than 40% between the most under doctored areas”—
	which include the area I represent—
	“and the areas with most GPs. Our most under doctored areas tend to be those with most deprivation, and therefore with the highest incidence of health inequalities.”
	The Centre for Workforce Intelligence analysis shows that GP coverage is especially critical in the north-west and north-east.
	I welcome my party’s announcement in this area and the important commitments that have been made to improve the NHS and, in particular, access to GPs. Our £2.5 billion Time to Care fund will help to integrate health and social care services, with more health services delivered in our communities. Inevitably, that will create additional pressures on primary care, and I fully support the aim of setting aside funding to employ 8,000 more GPs. I wish, however, to raise a question with my Front Benchers as well as the Government’s. Increasing the number of GPs alone will not address health inequalities, nor will it improve the health care services of my constituents if those resources are not properly targeted to the areas of greatest need, so I want to see real and practical solutions to the crisis.
	First, I would like the Government to take a long-term approach, targeting and offering careers advice to children in secondary schools, sixth forms and colleges in areas where there are GP shortages, raising aspirations and promoting medicine as a viable career choice. If we increased the number of people from the north-east going into medicine, we would increase the pool of medical students willing to work in our communities, particularly if they have an affinity with and personal connection to the health and well-being of the community where they would be in general practice. The problem is that many newly qualified medical students are going back to their home areas in the home counties in the south and south-east.
	Secondly, what steps are the Government taking to improve the number of GPs in under-doctored areas? Will they encourage postgraduate training in areas where there is the greatest work force need? One practical suggestion is to pay the student loans of medical students
	who are willing to work in under-doctored areas. In exchange, medical students would be expected to train and spend a specified number of years in employment in an under-served area. A survey by the BMA showed that up to 80% of medical students reacted positively to that option.
	I am delighted to support today’s motion. I am interested to hear the responses from the Front-Bench teams on how we intend not only to increase GP numbers but to target and direct GP services to the areas of the greatest need. Without that distinction GP services will never be sustainable in the areas of highest deprivation, and the very communities that need access to greater GP services, such as east Durham, will not have it.

Jamie Reed: I congratulate my hon. Friend the Member for Halton (Derek Twigg) and the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing this incredibly important debate. We have had a series of genuinely good speeches from right across the House. I thank the following for their contributions: the hon. Member for Henley (John Howell), my hon. Friend the Member for Walthamstow (Stella Creasy), the hon. Member for Truro and Falmouth (Sarah Newton), the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for North East Derbyshire (Natascha Engel), the hon. Member for Newton Abbot (Anne Marie Morris), who made a brilliant contribution, my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), and the hon. Member for Rochester and Strood (Mark Reckless), who told us about his constituents who have to wait up to six weeks for an appointment, which is clearly not acceptable,
	Finally, I thank my hon. Friend the Member for Easington (Grahame M. Morris), who made some incredibly important points. He mentioned that 1 million people today will visit a GP in England, and that 1.6 million will visit a pharmacist. Some of the answers to the questions he raised lie in making better use of the interfaces that patients have with medical professionals, whether it be GPs, nurse practitioners, district nurses or pharmacists. We need to look at the capacity that we have across the system to do more. He said that 30% of training places for GPs in the north-east remain unfilled, and I am with him on that. It is a real issue affecting my community in Cumbria. I hope he forgives me for calling him telepathic, but I think that we need to produce our own doctors to serve our communities.
	We should approach the Royal College of General Practitioners, higher education institutions and further education institutions about identifying people at a young age and encouraging them to go into medical careers and to stay in their communities to practise. I am trying to do that in my own community with the university of Central Lancashire. If that idea is to take wings, it will need significant support from the centre—the Department. Hopefully, we will reach a cross-party consensus on that. My hon. Friend hit the nail on the head with his practical solutions to the problems that so many communities face, particularly in the north-east, north-west and the midlands.
	I also extend my thanks to the Backbench Business Committee for ensuring that this debate took place. The sustainability of our GP services is crucial to the health of the nation and to the overall performance of the national health service.
	There are 372 million GP consultations each year and that number is rising. As my hon. Friend the Member for North East Derbyshire pointed out, around 90% of all patient contacts with the NHS are through a local GP. No one can dispute that GPs provide a vital service, but increasing pressures on this service are having a major impact on the NHS as a whole. The service does not exist in isolation, and so a holistic approach to our national health service must be taken if we are to have a system that is fit for the challenges of the 21st century.
	I wish to touch on three key tenets to our GP services: the issues surrounding the work force and the impact that they have on the profession; the concerns regarding access; and the wider impact that all these pressures are having on the NHS as a whole. Before I address those issues, I wish to pay tribute to the Royal College of General Practitioners and its chair, Dr Maureen Baker, for its Put Patients First campaign, which has put the problems facing general practice to the top of the political agenda. Like other MPs, I thank GPs around the country for their work under such extreme pressures. They really do perform superbly in difficult circumstances.
	The latest GP patient survey was a timely reminder of the problems facing both medical practitioners and patients. It found that one in four people is waiting a week or more for a GP appointment, or not getting one at all. If such a trend continues over the course of this Parliament, we will find that by 2020-21, the number will have risen to more than 22.5 million people. A Patients Association survey revealed that four in 10 people are concerned about the impact that the wait for a GP is having on their health. We may disagree over the causes of those concerns, but there can be no doubt that the Government have overseen a deterioration in the patient experience. Colleagues across the House will have repeatedly heard that from their constituents. Hopefully, the one thing we can all agree on is that there are not enough GPs.
	In March 2014, the Government’s taskforce report, “Securing the Future GP Workforce” was published. It said:
	“The taskforce has concluded that there is a GP workforce crisis which must be addressed immediately even to sustain the present role of General Practice in the NHS.”
	The Government’s own report paints a damning picture. It says that GP recruitment has remained “stubbornly below” the Government’s target, and that
	“this cumulative recruitment shortfall is being compounded by increasing numbers of trained GPs leaving the workforce, most significantly GPs approaching retirement, but perhaps more worryingly women in their 30s.”
	We have heard that concern from Members across the House.
	The report goes on to say:
	“Disturbingly, evidence is also emerging from the NHS Information Centre that the GP workforce is now shrinking rather than growing.”
	It also shows that the number of GPs per head has fallen below levels seen in 2009. At a time when demand is rising, such a reduction is having a profound impact on the service that GPs can provide. We know from personal experience and from our constituents that the vast majority of GPs work tirelessly in extremely trying conditions to provide the best care possible for their patients, but under this Government that is becoming harder and harder for patient and practitioner alike.
	I speak to GPs from all around the country, including in my constituency, who are on the verge of burning out. GPs are concerned that they are so overworked that they are at risk of harming a patient. I have written to the Secretary of State with regard to comments made to me by a local GP, who said that unless something changes, unless recruitment improves and unless service pressures ease, “we are going to kill someone”. Clearly, that is an untenable and unacceptable state of affairs.
	The increase in demand and workload is having a detrimental impact on the morale of GPs. A BMA survey in March last year revealed that more than half of GPs reported that their morale was either “ low” or “very low”. This is a matter not of professional whinging, but of patient safety. The chair of the BMA GP committee said at the time of that report:
	“It is clear that General Practice is facing a workload disaster that is threatening its long-term future.”
	The Government’s inaction is only making things worse. The work force issues that I have outlined now mean that more GPs are considering early retirement, thus potentially exacerbating an already unsustainable situation. The BMA survey showed that more than a quarter of GPs were considering leaving the profession, six out of 10 were considering early retirement, and a third were already planning for that decision. Instead of delaying, I hope that, in the days remaining before the election, the Government will back Labour’s Time to Care fund, which, with a budget of £2.5 billion a year, would recruit 8,000 more doctors, 5,000 more care workers and tens of thousands of other new staff by 2020. We would do that by taxing mansions, clamping down on tax avoidance, and raising a levy on tobacco companies. We can fund new medical professionals to ease the work force pressures and to give GPs the support that they need to provide a service on which we all rely.
	In response to Labour’s announcement on the Time to Care fund, particularly on our pledge to produce 8,000 more doctors, the chair of the Royal College of General Practitioners, Dr Maureen Baker said:
	“It is good to see that the Labour Party have recognised the resource and workforce pressures facing General Practice and their pledge of 8,000 more GPs by 2020—something the RCGP has long called for—is very welcome.”
	In contrast, the Government have missed their own recruitment target, which is having a profound impact on the overall service. I hope that they will back our plans to ease the work force crisis that they have, in part, helped to create.
	Moving on to access, despite the best efforts of GPs and other professionals, work force pressures are having adverse effects on patient experience. More than one in four people do not get a GP appointment within a week. The GP patient survey shows a deterioration in access to GP services. When Labour left office, the vast majority of patients could get an appointment within 48 hours, but one of the first acts of this Government—
	something I am sure that they now regret—was to scrap Labour’s guarantee. As a result, it is now getting harder and harder for patients to see their GPs. That is not surprising, given the worsening work force pressures that the Government have presided over.
	The Government have failed not just on overall access, but on the continuity of care. They talk of the continuity of care and access to a named GP, yet the GP patient survey shows that one in five people are unable to see their preferred GPs regularly. This, too, is unacceptable. The overall picture of GP access is one of deterioration, not improvement. The Government have heaped pressure on primary care, and now, as we all know from our constituency surgeries, patients are feeling the effects.
	By cutting competition and rolling back the market that the Government have imposed on the NHS, Labour has committed to investing an extra £100 million to deliver new options for GP access. The Government should back Labour’s plans to give patients three options for accessing their GP: first, a same-day consultation at their GP surgery; secondly, a GP appointment at their surgery within 48 hours; and thirdly, the ability to book ahead to see the GP of their choice. All Members who have spoken today have raised precisely such issues, and only the Labour party has produced the solutions to those issues, which so many constituents are taking to colleagues. Where possible, some GP surgeries already provide those options, and with Labour’s extra funding and new doctors, we want to give all practices the ability to deliver them.
	Timely access to GP services is essential for the whole NHS. The GP patient survey has shown that almost 1 million people have gone to A and E because they were unable to get a convenient GP appointment. That is creating unprecedented demand on our A and E departments, manifesting itself in the number of patients now waiting for more than four hours—something that we all see—and causing reverberations throughout the whole system. The Government’s cuts to social care have also increased pressure on primary care services, and that, in turn, is also increasing pressures on A and E
	The constituent services of the NHS do not exist in isolation, and the Government’s failings in easing work force pressures for GPs have had profound effects throughout the system. Instead of addressing these issues, most of which were predictable, the Government blew precious time and more than £3 billion on a reorganisation that was deliberately hidden from the public before the last general election. Only by backing Labour’s plans for thousands of new doctors, funding to improve GP access, and moving towards the greater integration of health and social care, can we really ensure that all parts of the NHS, including GP services, are sustainable for the future.
	We have heard about profound difficulties in Walthamstow and other communities. I am one of those fathers who hang on the phone for 30 minutes or longer, trying to get an appointment for a sick child. I do not blame GPs; they are under huge pressures and we have heard about recruitment problems all over the country. I have written to the Secretary of State for Health about recruitment problems in Cumbria, but sadly, I have yet to receive a reply. Will the Minister, if nothing else today, commit to write to every Member who has expressed concerns in the debate to illustrate in
	detail what the Government will now do to help those communities to assist with GP recruitment and sustainability? Universal services require universal standards and the ability of patients to access these services universally.

Daniel Poulter: I thank the hon. Members for Halton (Derek Twigg) and for Brighton, Pavilion (Caroline Lucas) for securing this debate today. I commend them for raising important issues about the resourcing of general practice, access to GP services and the future shape of general practice and how it will continue to deliver high-quality care to patients. In particular, I should like to praise the many GPs who work exceptionally hard every day for our NHS and deliver high-quality care to patients.
	The hon. Member for Halton made some other important points about mental health training for GPs. Historically, GPs have not always received training in mental health. That must change. The Royal College of General Practitioners and the Royal College of Psychiatrists support that change, and that is why we have stipulated in Health Education England’s mandate that GPs should receive compulsory training in mental health in future. Health Education England is now working with the royal colleges to put that in place. That important step forward will benefit many patients throughout the country.
	I will ask my right hon. and noble Friend Lord Howe to look into the issues raised by the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) and to get back to them in due course. Although the hon. Member for Halton raised some important issues, some of which were echoed by the shadow Minister, the hon. Member for Copeland (Mr Reed), it is frankly not good enough to complain now about a GP work force crisis when they were in power for 13 years. It takes three years from the end of foundation training to train a GP, and training a part-time GP takes longer. If there is a work force crisis in general practice, it is because the previous Labour Government did not have the foresight to train enough GPs when they were in power.

Derek Twigg: rose—

Daniel Poulter: I will give way in a moment.
	Under this Government, 1,000 more GPs are working in the NHS or training. That is a move in the right direction. We have put in place long-term work force plans to ensure that there are 5,000 more by 2020. We have recognised the pressure that GPs are under, and we have trained and are training more. I hope that the hon. Gentleman will do better than he did in his speech and at least acknowledge the point I have made.

Derek Twigg: With respect to the Minister, I am not suggesting that everything that the Labour Government did was perfect or that we met every demand on us. I tried to make it clear, although he does not want to recognise this, that there were massive improvements in the number of GPs. The Library’s figures for 2003 to 2009 show an extra 5,000 GPs. Many of the GPs now coming into place were trained under the Labour Government.

Daniel Poulter: Indeed, there was an increase in the number of GPs, as there has been under this Government, but it is not good enough to lay the blame for a lack of GPs at this Government’s door, as the hon. Gentleman and the shadow Minister tried to do, when it takes a long time to train more GPs. What may have been a better decision for the previous Government in the advanced work force planning would have been to follow this Government’s example, by saying that 50% of medical graduates should become GPs. Currently, the rate is 40%. That needs to rise to 50%, and we need to encourage more people to become GPs. If we had more equality in where medical graduates end up practising medicine, that would be a big step in the right direction in training the extra GPs needed. If that had been done 10 years ago, we might not have some of the problems that the hon. Gentleman outlined. Indeed, he said that only 27% of GPs were under the age of 40. That reinforces my point about medical graduates.

Duncan Hames: I agree with the Minister that there is no substitute for persuading more medical graduates to train as GPs, but will he look at what can be done to attract women who were GPs back into general practice after they have started a family if that was the reason why they left? Will he also look at the working practices that we require of GPs to find out how that can be a more reliable way to make the most of the GP training that we have committed to?

Daniel Poulter: Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.

Grahame Morris: Will the Minister give way?

Daniel Poulter: I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.
	General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.
	On work force issues, being a GP is still a rewarding and well paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.
	Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.

Grahame Morris: Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?

Daniel Poulter: The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.
	One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and
	Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.

Sarah Newton: Does my hon. Friend agree that the university of Exeter medical school at the Royal Cornwall hospital is an important medical school because it enables people to see general practice in remote rural communities? We know from previous contributions to the debate that that is important in attracting people into remote rural areas.

Daniel Poulter: My hon. Friend is right. I spoke to medical students and those teaching them in Cornwall on a visit earlier this year. It is important, particularly for rural areas, to encourage more placements in rural areas in general practice. Often at my hon. Friend’s medical school and other medical schools in remote rural areas, there is a good track record of recruiting more local young people so that they are being educated locally. The hope is that those people will stay and work in the local work force and contribute to the local NHS after they graduate. I hope all hon. Members will agree that that is a good thing, particularly in more deprived areas.
	I must make progress as I do not want to intrude upon the House’s time for too much longer. There are two or three important points that I want to make. I mentioned that in the health education mandate in 2014 we mandated to increase the number of GP trainees from 40% to 50% of all trainee doctors. That will make 5,000 extra GPs available by 2020. It is important to note, however, that as well as having the appropriate size work force, we must plan for the future shape of the work force. The new models of care set out in the NHS England “Five Year Forward View” will require different models of staffing, and we need to plan with that in mind. That is why Health Education England has established an independent primary care work force commission, chaired by Professor Martin Roland of the university of Cambridge.
	In line with the contributions to the debate from a number of hon. Members, including my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), the commission will identify models of primary care that will meet the needs of the future NHS, including a greater emphasis on community and primary services and the more integrated delivery of care, which will involve the better use of multidisciplinary teams. We have been talking about GPs today, but delivering better care in the community is also about nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists and the many other health care professionals who play a part in delivering high-quality care to patients in general practices and in the community every day through our NHS.
	In response to concerns raised by hon. Members about access to services, GP services need to be available to patients in a convenient place and at a convenient time. Achieving improved access to general practice not only benefits patients, but has the potential to create more efficient ways of working, which benefits GPs, practice staff and patients. The previous Government attempted to improve access to GP services by establishing
	a 48-hour access target. We know now that that target did not work. From 2007 to 2010, the proportion of patients who were able to get an appointment within 48 hours when they wanted one declined by 6%.
	A 48-hour target can make it more difficult for some of the more vulnerable patient groups who GPs look after, particularly people with complex medical co-morbidities, to get the important routine appointments that they need. We should bear in mind that targets can be perverse. That target did not work in its own right, and could make it more difficult for people with complex needs and the vulnerable and frail elderly to get the routine appointments that keep them well and properly supported in the community.
	Many points have been made about Labour’s disastrous 2004 GP contract. I do not need to rehearse those. The single biggest barrier to access to care is not being able to see their GP when people need to, in the evenings and at weekends. We have put together the Prime Minister’s fund with £100 million to back it to improve access to GP services in the evenings and at weekends, to make sure that patients receive the better service that they deserve.

Jamie Reed: In 1997, only half of patients could see a GP within 48 hours. By 2010 the vast majority could do so. Does the Minister agree with Maureen Baker of the Royal College of General Practitioners, who said:
	“It is ludicrous to continue to blame a GP-contract that is more than ten years old for the woes currently besetting the entire NHS”?

Daniel Poulter: It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.
	Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.

John Baron: Will my hon. Friend give way?

Daniel Poulter: I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.
	As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we
	have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.

Stella Creasy: Will the Minister give way?

Daniel Poulter: I will give way one last time, but then I will have to conclude.

Stella Creasy: In my contribution I specifically asked the Minister whether he would commit to a review of GP access in Walthamstow because of the combination of problems—the two-week wait for appointments, the poor quality of surgeries and the single-practice GPs. Will he make that commitment today to the people of Walthamstow?

Daniel Poulter: I hope that I have given the hon. Lady some reassurance about the Government’s commitment to invest £1 billion in primary and community care infrastructure over the next four years, which will help many local GPs. I also gave a reassurance to her hon. Friends earlier in the debate. I will certainly ask my noble Friend Earl Howe to look into the matter and write to her. He might also be available for a meeting, if time permits, before the end of this Parliament.
	Integrating care is of course a priority for the Government. The better care fund has already made headway by combining £5.3 billion of existing funding into local authorities and the NHS—combining health and social care pots, which will be of great benefit to the frail elderly and people with long-term conditions such as dementia and heart disease. In addition, we have backed the new models of care set out in NHS England’s “Five Year Forward View”, with a £200 million transformation fund. That will allow the NHS to pilot new models, such as multi-speciality community providers, which aim to provide more proactive, person-centred and joined-up care.
	In conclusion, the initiatives that I have described are geared around not only increasing the cash and resources available for general practice in the short term, but radically transforming the way we deliver care, which will ensure that we have GP services fit for the future.

Gerald Howarth: Will my hon. Friend give way?

Daniel Poulter: I will take one last intervention.

Gerald Howarth: I am extremely grateful to my hon. Friend and to the House, because I have been following this important debate not only occasionally in the Chamber, but on the screens. In the area around Aldershot and Camberley, GPs have got together to
	provide out-of-hours services run by them, and it works, so there are good practices providing accessible out-of-hours services, where GPs have come together to provide that cover for their patients, not for other surgeries’ patients.

Daniel Poulter: My hon. Friend makes an important point. We talked earlier about the GP contract changes in 2004. Many local GPs have recognised the barriers that can be put in the way of delivering high-quality, local patient care and have worked together to provide local solutions. My right hon. Friend the Prime Minister has provided £100 million to support the return to seven-days-a-week services, and I think that rural practices will increasingly want to bid for that fund. Initial funding has predominantly gone to urban areas, but areas such as Suffolk are now looking to bid, because local GPs recognise that it is in the best interests of patients to provide locally run, seven-days-a-week services. I commend my hon. Friend’s local GPs for what they are doing to deliver that care in Aldershot.
	Under this Government, more money is going to general practice. We have returned to having a dedicated GP for every patient. There are over 1,000 more GPs, and we plan to train 5,000 more. If we have a Conservative-led Government after May, we will return to seven-days-a-week GP care for all by 2020. This Government are backing GPs and delivering the care that patients deserve.

Derek Twigg: I reiterate my thanks to my hon. Friend the Member for North East Derbyshire (Natascha Engel) and her colleagues on the Backbench Business Committee for finding the time for this important debate. I also thank my hon. Friend the shadow Minister and the Minister for their responses to the debate, whatever disagreements we might have.
	We have had a very interesting debate. Every contribution has been important and well thought out. Many hon. Members made important points about their constituencies and the problems they face in general practice and other areas of health care. It has been a good opportunity to expose those issues. Having heard what they have said, I am in no doubt that there is a real problem with access to GPs in many areas, although in some areas access is worse than in others. There is a need to recruit more GPs and to get to better grips with the work force and how we recruit to general practice.
	Without a doubt more needs to be done. We need to ensure that GP services are available to provide the best possible health care for our constituents. The pressures that GPs are currently facing and the lack of access in some areas is clearly putting that at risk. I hope that the Minister has listened carefully to the arguments made by colleagues today, because certainly more needs to be done.
	Question put and agreed to.
	Resolved,
	That this House notes the vital role played by local GP services in communities throughout the UK, with an estimated one million patients receiving care from a family doctor or nurse every day; believes that the UK’s tradition of excellent general practice provision is a central factor in the NHS being consistently ranked as one of the world’s best health services by the independent Commonwealth Fund; expresses concern, therefore, that the Royal College of General Practitioners (RCGP), through its Put patients first: Back general practice campaign, is warning that these
	services are under severe strain, with increasing concerns raised by constituents about access to their GP and 91 per cent of GPs saying general practice does not have sufficient resources to deliver high quality patient care; further notes that the share of NHS funding spent on general practice has fallen to an all-time low of 8.3 per cent, and that over 300,000 people across the UK have signed the campaign petition calling for this trend to be reversed; welcomes the emphasis placed in NHS England’s Five Year Forward View on strengthening general practice and giving GPs a central role in developing new models of care integrated around patients; and calls on the Secretary of State for Health to work with NHS England and the RCGP to secure the financial future of local GP services as a matter of urgency.

Improving Cancer Outcomes

John Baron: I beg to move,
	That this House has considered improving cancer outcomes.
	Recent analysis from Macmillan Cancer Support shows that there are now an estimated 2.5 million people living with cancer in this country—an increase of almost half a million over the past five years. May I therefore begin by thanking the Backbench Business Committee for granting this timely debate on an issue that is becoming ever more urgent: improving cancer outcomes?
	I would also like to thank my fellow officers of the all-party group on cancer for all their hard work, and the officers of the other cancer-specific all-party groups. It speaks volumes about the importance of the issue that we have come together to secure this timely and important debate. I would like to give the all-party group on cancer a plug. The group is recognised as the wider cancer community’s voice in Parliament. It has a proud campaigning track record. It runs what is now the largest one-day conference on cancer in the UK—Britain against cancer—each December. In the Minister’s own words, it rightly holds the Government’s feet to the flames.
	The timing of this debate is crucial. With only a matter of weeks of parliamentary time before the general election, and at a time when NHS England is embarking on a new cancer strategy, this is likely to be the last opportunity for this Parliament to speak up on behalf of the cancer community and feed into that strategy.
	The challenge has never been greater. Macmillan Cancer Support estimates that 3 million people will be living with cancer in this country by the end of the next Parliament. By the end of next year, 1,000 people a day are expected to be diagnosed with cancer. Hospital admissions for cancer in England have increased by around 100,000 a year, compared with five years ago. The NHS has missed the target of cancer patients receiving their first treatment within 62 days of an urgent referral for three quarters.
	There is also good news, though, in that we have certainly made improvements in cancer outcomes over the past few decades. The latest figures published in December show that the one-year cancer survival rates in the UK now average 68.5% to 69%—up by a full 10 percentage points since 1997. These are figures on a page, but we are talking about thousands of lives saved every single year because we are driving up cancer survival rates, particularly in the one-year figures.
	However, those improvements have been gradual and incremental, and they have not been enough to catch up with our European counterparts. Research has shown that our one-year survival rates still significantly lag behind European averages. Whereas we have 68.5% to 69% in this country, the best in Europe is 81% to 82% in Sweden. That is a significant difference that accounts, very roughly, for some 10,000 lives a year. There is always a danger in making comparisons. For example, if we look at the French figures, we are making comparisons with France’s centres of excellence. None the less, the established evidence suggests that we are down by some
	5,000 lives a year on European averages, and perhaps by as many as 10,000 when compared with the best in Europe.

Edward Leigh: That is why we want an open debate about the future of the NHS. We need to recognise that the social insurance systems in France and Germany produce better outcomes for people than our own national health service.

John Baron: That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.
	The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.
	I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.
	Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.
	With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.
	I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.

Liz McInnes: Does the hon. Gentleman agree that we need to look at the age range for cervical cancer screening? Only this morning, I heard of a 21-year-old who was found to be suffering from this disease, and who had begged the GP to give her a screening test but was unable to get it until it was too late. We also have a problem at the older end of the spectrum above the age of 64.

John Baron: Obviously, I cannot comment on the specific case, but I repeat that putting the one-year figures up in lights will put pressure—the best kind of pressure—on CCGs to look at all the initiatives at their command.
	I do not think that the Department of Health or NHS England should be too prescriptive about this. We have CCG managements earning six-figure salaries who should, frankly, be able to make these sorts of decisions by introducing initiatives that best suit their populations. Where there is, say, a black and minority ethnic population, an elderly population, or a mining community population, initiatives have to be skewed accordingly, and that is what CCG managements should be doing. We have to leave an element of local initiative. One cannot just sign a cheque to the NHS for £120 billion and not expect accountability. By putting CCGs’ one-year figures up in lights, we can, over a period of time—there is no quick fix—monitor how they are doing. In the case that the hon. Lady mentioned, I would hope that the CCG would have a look at local initiatives that could perhaps change the situation for the better.

Rebecca Harris: I, too, welcome the one-year survival rates being put up in lights. Does my hon. Friend agree that there may be a risk of missing rarer cancers such as brain tumours in a drive to catch what might be seen as the low-hanging fruit through screening processes?

John Baron: That is a very good point, and I will touch on it briefly later; I know that my hon. Friend will do so as well. I agree that there is a danger of that. We need to raise our one-year figures significantly—not by just a few percentage points; if we want to be among the best in Europe, then it has to be by 10 percentage points—and that means that we cannot exclude a lot of the rarer cancers, because there is only so much low-hanging fruit. I hope that this sends out a general message that there must be initiatives across the whole spectrum of all 200 cancers. The rarer cancers are the
	poor cousin at the moment, and we need to address that specifically. I look forward to hearing what my hon. Friend says later.
	Let me explain why it was important to get the one-year figures into the delivery dashboard. We were told that it was all very well to get them into the outcomes indicator set, but they also needed to get into the top tier of NHS accountability—namely, the delivery dashboard. Chief executives of CCGs have told us that they felt they were monitored on that delivery dashboard, or—shall I put it this way—that that was their first port of call.
	It is great to be able to inform the House that cancer is now the only disease-specific outcome indicator on the delivery dashboard. I say “great” in the sense that I am delighted that cancer is included, although I wish the delivery dashboard had more outcome indicators, not just process indicators. Processes are fine, but they do not necessarily lead to better outcomes. In my view, if we are serious about improving outcomes, the more outcome indicators we can get on to the delivery dashboard across a range of diseases, the better.
	Getting the one-year figures on to the delivery dashboard will be transformational only if we use the tools in the toolbox and ensure that CCGs are held to account effectively. That means not only addressing poor performance, but encouraging those with the highest survival rates in the UK to continue to strive for improvement. There is no point having such figures if we do not use them. Will the Minister clarify how CCGs are being made aware of the upcoming changes to accountability? More importantly, what measures will NHS England take to address underperformance in one-year cancer survival rates by CCGs?
	On survival rates, I want to touch on another issue that the all-party group has campaigned on—inequalities. Our recent report, “Cancer across the Domains: A vision for 2020”, particularly highlighted the poorer outcomes for older people. We are not the only ones to have drawn attention to the issue. A recent report from the National Cancer Intelligence Network noted that
	“over half of all cancer deaths occur in people aged 75 and over”.
	A National Audit Office report on cancer services, published last month, found that
	“cancer patients aged 55-64 are 20% more likely to survive for at least 1 year after diagnosis than those aged 75-99.”
	Such variation is completely unacceptable. Evidence suggests that the under-treatment of older people happens because some clinicians base their prescriptions on chronological age, not necessarily on their fitness to receive treatment. There is general recognition that older people suffer worse outcomes. The NAO report accepted that
	“survival rates for older people are expected to be lower”,
	but stated that
	“this is unlikely to explain fully the significant variation between age groups.”
	I suggest that we need to look at that issue. The all-party group on cancer welcomes the increased focus on it. However, we must ensure that such focus results in action and, as with early diagnosis, that the right accountability levers are in place to deliver real change.
	Our recent report highlights our concerns about the fact that all the cancer mortality indicators in the NHS outcomes framework are for under-75s. It is almost as though the NHS has made a decision that the lives of
	those over 75 are worth just a little bit less than those under 75. That impression has been created in certain quarters, and we need to address that perception. We believe that it sends the wrong message about the importance of older people with cancer. Will the Minister outline what steps the Department is taking to tackle the inequalities faced by older people with cancer?
	To move on to patient experience, we tend to think of outcomes simply as survival rates, but it is essential for the NHS to deliver good outcomes for patients at every stage of the cancer pathway. Members will be aware that tomorrow marks two years since the report of the Francis inquiry into the Mid Staffordshire scandal. It therefore feels like an appropriate moment to highlight the importance of the patient experience not as an add-on or a facility that is nice to have, but as an integral part of how we deliver cancer care.
	The cancer patient experience survey has given us valuable insight into the experience of cancer patients in the UK. The findings continue to reveal widespread variation in the experience of care that people receive. For example, people with rarer cancers, which were mentioned by my hon. Friend the Member for Castle Point (Rebecca Harris), continue to report poorer experiences than those with more common cancers. The same is true of people with long-term conditions, younger patients, older patients, some ethnic minority patients and patients treated in London hospitals. That widespread variation is unacceptable.
	Such an insight is worth very little if we do not ensure that it is used to drive real change. I suggest to the Minister that the mechanisms for doing so simply do not exist at the moment, or if they do, they are disparate and unco-ordinated. The all-party group has real concerns. We know that some trusts develop action plans based on CPES results, but there is no requirement for them to do so. NHS England does not require trusts to report on results. CCGs and NHS England do not seem actively to measure NHS trusts’ progress against their action plans to improve their scores. All that leads to a gap in accountability on the cancer patient experience. There are still concerns about the accessibility of the data from trusts and other local bodies for patients. For example, trust-level reports do not seem to be available on official NHS websites.
	The all-party group was pleased that the Minister, in her response to “Cancer across the Domains”, confirmed there were no plans to discontinue the CPES. However, we were concerned to hear that, due to procurement issues, the CPES may not report in 2015. Will she provide an update on whether it will report results in 2015? Perhaps more importantly, will she clarify how NHS England will ensure that the CPES is used to drive improvements in the cancer patient experience, and to hold trusts and CCGs to account?

Jack Lopresti: Aside from my hon. Friend’s points about the strategic level of decision making and accountability, does he agree that at an individual level it is crucial to have complete clarity, understanding and credibility from the point of view of the consultant and the patient, and that there should not be any room for ambiguity or confusion?

John Baron: My hon. Friend makes an excellent point. Good communication and indeed consultation is terribly important, and it is one of the key issues that the cancer
	patient experience survey addresses in trying to gauge patients’ experiences. The NHS can sometimes forget that patients with cancer, like those with long-term conditions generally, are often very knowledgeable about their condition. They need to be consulted, and there must be better communication. That is why we should formulate the cancer patient experience survey better, and ensure we draw out the lessons to be learned so that we can take action to improve experience. I completely agree with my hon. Friend, and I look forward to hearing his speech.
	Finally, may I touch briefly on data access? The effective use of data is the foundation for improving cancer outcomes. Good data are at the epicentre of how we are going to improve outcomes. However, I suggest to the Minister that there are problems. Health charities play a crucial role in driving improvements in the health service, including in cancer services. For example, Macmillan’s research has provided invaluable new insight into patient clinical outcomes and the accuracy of GP cancer referrals, which has helped to improve services. However, charities and others are finding it increasingly difficult to access routinely collected data, leaving vital projects stranded for months. In some cases, they do not get the data at all.
	There are a number of reasons for that. First, information governance rules are being applied inconsistently. Changes to the legal status of bodies under the NHS reforms have led to confusion about who data can be shared with and, in some cases, have reduced the capacity for analysis. Secondly, different parts of the system are failing to work together. Both nationally and locally, organisations are adopting an increasingly fragmented approach. Furthermore, organisations that are responsible for releasing data do not appear to have the capacity to do so. In a recent Public Accounts Committee hearing, Cancer Research UK indicated that the research group had been waiting 16 months to access data on cancer waiting times.
	As the Minister will know, the recent National Audit Office report on cancer services made recommendations on that issue. First, it recommended that the Health and Social Care Information Centre should be
	“held to account for how effectively it is discharging its responsibility to disseminate data to help drive improvements”.
	Secondly, it recommended:
	“As a minimum, it should seek, and publish the results of, regular feedback from NHS data users.”
	The cancer community was concerned to hear Sean Duffy call for greater pressure to release and use data at our Britain against cancer conference. To me, that sent a clear signal that further leadership from the Government was needed on this issue. When she responds, will the Minister outline what plans the Department has to clarify the data access rules and to ensure that they are applied consistently, so that we can plan and make proper use of them? That is the essential point.
	In conclusion, I thank the Minister for being here and for being prepared to respond to the debate. I have not had a chance to cover a great number of areas, including inequalities more generally, cancer commissioning and survivorship to name a few. However, I hope and expect that other Members will touch on those important
	issues. I will end where I began: by focusing not only on the scale of the challenge facing us, with the news that 3 million people will be living with cancer by the end of the next Parliament, but on the opportunity. Because of many of our campaigns over the past few years, the NHS now has the tools that it needs to accelerate the improvements in cancer survival rates. The challenge that I set for the Minister today is to ensure that NHS England uses those tools to full effect to deliver the best outcomes in Europe and, quite literally, to save tens of thousands of lives.

Sharon Hodgson: I am pleased to speak in this important debate. I thank the Backbench Business Committee for granting such an important debate and the hon. Member for Basildon and Billericay (Mr Baron) for applying for it. His excellent speech showed his knowledge on and passion for this subject. I commend him for all the work that he has done over the years.
	I would also like to acknowledge the dedicated work of three amazing women who sadly lost their lives to ovarian cancer: Eilish Hoole, who sadly lost her battle in July last year; Chris Shagouri, who worked tirelessly with her MP, the hon. Member for Pudsey (Stuart Andrew); and Jenny Bogle, who, thanks to her MP, my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), was the only patient to give evidence to the Health and Social Care Public Bill Committee in 2011. They were fearless campaigners who regularly attended events in this House to lobby us all for greater awareness of this terrible disease, and they will be sorely missed.
	It is estimated that by 2020, roughly half the population of this country can expect to be diagnosed with a form of cancer in their lifetime, so improving outcomes has never been more important. One major way to do that is to push for ever-greater awareness of the many different forms of the disease, from causes and symptoms through to treatments. With that in mind, I will focus on ovarian cancer—a subject that I know well as chair of the all-party parliamentary group on ovarian cancer.
	Ovarian cancer is the fourth most deadly cancer for women in this country, with more than 4,000 women a year dying of the disease. That is 12 mothers, sisters or daughters dying every single day. One of the biggest reasons why it is so deadly is that the vast majority of women are diagnosed too late, meaning that their chances of survival are extremely poor. That contrasts hugely with those who are diagnosed early, up to 90% of whom survive. Put simply, if all cases were caught early enough, thousands more women would survive this terrible disease each year.
	The biggest barrier to that happening is a profound lack of awareness of ovarian cancer and its symptoms. If I were to ask women up and down the country to name the key symptoms of early-stage ovarian cancer, such as persistent bloating, difficulty eating, feeling full quickly and persistent abdominal pain, the vast majority would not be able to do so.
	A study by Target Ovarian Cancer last year found that only 3% of women surveyed were really confident about spotting any of the symptoms of the disease, and another study found that nearly half of women believed
	incorrectly that cervical screening is able to detect ovarian cancer, making them much less likely to be on the lookout for symptoms themselves—even if they knew what those symptoms were. It is also believed that GPs have a harder time spotting symptoms for ovarian cancer than for many other types of cancer, as it is classed as a rarer cancer and, according to the NHS “Five Year Forward View”, it is estimated that the average GP will see a rare cancer only once in their entire career.
	Disappointingly, that was one of the few mentions of cancer in that report. In fact, the only section on the disease features in the last two pages. It appears to have been a late addition, as it does not even feature in the contents page. However brief the mention, it does make a couple of good points. It says that we need an NHS that
	“works proactively with other partners to maintain and improve health”.
	It also recommends that, because of the rarity of some forms of cancer, we need to give GPs support to
	“spot suspicious combinations of symptoms”.
	It also says that
	“as well as supporting clinicians to spot cancers earlier, we need to support people to visit their GP at the first sign of something suspicious”.
	It predicts that achieving that would mean 8,000 more patients living longer than five years post-diagnosis.
	After reading that commendable statement, I was disappointed to hear from the NHS’s national clinical director for cancer, Sean Duffy, at our last all-party group meeting on ovarian cancer, that ovarian cancer may not be included in the Be Clear on Cancer campaign. That seems to me to be contrary to what the NHS report recommends. Perhaps the Minister will be able to tell the House whether any such decision has been taken and, if not, that she will work with me to ensure that ovarian cancer is included.
	I would also like to know from the Minister whether the lack of focus on cancer more generally is a result of the Health and Social Care Act 2012. As co-chair of the all-party group on breast cancer, I have spoken to several leading breast cancer charities, which have told me that the Government’s reorganisation has ended up reducing the capacity of the NHS to deal with cancer services, not least through the dissolution of the cancer policy team in the Department of Health and the dedicated cancer networks locally. At a time when more people than ever are getting cancer, it is worrying to see changes to our NHS that have significantly reduced our ability to deal effectively with this awful disease.
	Cancer is life-threatening, but in many cases ignorance can be the biggest killer. In 2013, the all-party group on breast cancer published an excellent report that highlighted the fact that older women are lagging behind in early diagnosis of breast cancer, partly through a lack of awareness of the symptoms, and we laid out a clear set of recommendations to help deal with the problem. If that is the case for a cancer as common and as well understood as breast cancer, it is even more difficult for the rarer cancers such as ovarian cancer to be understood, spotted, diagnosed and treated in good time. That is why raising awareness among the general public is more critical now than ever. Unlike with breast cancer, there is no workable national screening programme for ovarian
	cancer, so it is even more important to get the message out about it. We have the tools at our disposal to do so almost straight away.
	The Government’s Be Clear on Cancer campaign ran a pilot study in 2013, in which areas of the country were the subject of ovarian cancer awareness campaigns. I commend the former Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), on his excellent work in this area. He met members of the all-party group to discuss the awareness campaign, which ultimately led to the pilots. The results from the campaign were extremely positive. More women remembered seeing the awareness campaign materials, there were higher levels of women going to see their GPs about possible symptoms and, crucially, more women than ever recognised key symptoms and demonstrated greater overall knowledge of ovarian cancer than women from other parts of the country who were not part of the campaign.
	Last year, another pilot was launched in the north-west region. Sean Duffy reported back to the all-party group on ovarian cancer that the pilot may not lead to the desired roll-out, so perhaps the Minister will be able to let the House know when the full results of that study will be released and whether they differ significantly from the previous report, which pointed to greater awareness having been generated by the campaign. By making sure that ovarian cancer features in the national Be Clear on Cancer campaign, we can make sure that everyone is better informed. We can get women to see their GPs earlier and, ultimately, we can save lives. To that end, I have continually pressed hard for the full inclusion of ovarian cancer in the national campaign. I ask the Government to look at the evidence and the potential life-saving outcomes that could come from its inclusion, and commit to making sure it forms part of the national strategy. Most paths to reducing cancer deaths are time consuming, costly and hard to achieve, but this decision could be taken quickly and easily, and it will save lives.
	Cancer treatment is not just about survival rates; it is also about post-treatment care and quality of life. No matter what kind of cancer people are living with, we must ensure that the NHS and the Government are committed to helping them at all stages. This is only possible, however, once we raise enough awareness of all forms of the disease. We will then be able to make the improvement in cancer outcomes that every patient needs and deserves.
	Finally, on the broader point of awareness, I was shocked recently to discover, after a meeting with Orin Lewis of the National BME Cancer Alliance, the huge disparities that exist in cancer awareness, diagnosis and treatment between white patients and those of a black and minority ethnic background. Incident rates of myeloma in African and African-Caribbean people are twice as high as for white people. Similarly, rates of mouth cancer among Asian women are 50% higher than for white women. Before the great work of Orin, there were a shockingly low number of BME bone marrow donors on the national register. I pay tribute to his work on this: it has led to a substantial improvement, although it still remains disproportionately low.
	BME patients routinely rate their care experiences less positively than white patients. Even things as simple as having racially sensitive prosthetics or wigs when going through already traumatic experiences and cancer
	treatments are not properly taken into consideration. The list of discrepancies throughout every stage of the cancer journey for BME patients is long, shocking and deeply alarming. Alongside promoting greater awareness of cancer in general, it is critical that the Government and the NHS work with BME communities to make sure that national campaigns are designed to be absorbed by as many different people as possible, each with their own distinct cultures, religious practices and biological differences.
	Improving cancer outcomes means improving cancer outcomes for everyone. I will continue to work on this specific issue to address the clear and present problems in the current system. I urge the Government and the NHS to give this real thought. If the Minister would like more information on any of the issues I have raised today, I am more than happy to meet her to discuss them further. I know we both share the same goal: to improve cancer outcomes for all.

Rebecca Harris: As one of the co-sponsors of the debate and as chair of the all-party group on brain tumours, I thank the Backbench Business Committee for scheduling the debate and the Minister for her presence in the Chamber. This is a timely debate: yesterday was world cancer day. It is also timely for me for another reason, which I will come on to later. I think we all agree on the importance of raising awareness of early diagnosis and I will come on to talk about that, but world cancer day has done an enormous amount of work with the many cancer charities to raise awareness of the risk of cancer. We are much more likely to spot the initial signs of the disease, but I think the consensus is that there is still a way to go.
	I would first like to share the story of the Green family in my constituency. Their son Danny, who was a happy, sporty, energetic 10-year-old, suffered a dizzy spell after playing football. After a few days of being unwell his parents, Chris and Lisa, were very concerned about this health and took him to hospital. They were turned away and told that he had a migraine. After trying hard to persuade doctors that this was not how their son was normally and that it was not just a migraine, the family took him back to hospital and asked for a scan, only to be told that a scan could take months to schedule. Only when he collapsed in hospital, was he rushed to have a CAT and MRI scan.
	Danny was taken straight to Great Ormond Street hospital, where he received incredibly good care. His brain tumour was removed and he stayed in hospital for many months fighting a little-known unfortunate side effect of brain tumour surgery—something called posterior fossa syndrome—that left him badly disabled and unable to speak. Unfortunately, the cancer came back. After a heavy course of chemotherapy it started to shrink again, but tragically, Danny lost his life after contracting pneumonia and another virus in Great Ormond Street in July 2012.
	Like many people, the Greens had taken someone to hospital with balance problems and headaches that were dismissed as a migraine. Far too many people finally get treatment only after having had the symptoms for a long time. Mercifully, brain tumours are rare, but
	that is the problem, because rare cancers are not sufficiently picked up. The Greens would like to see patients displaying possible symptoms of brain tumours given scans much earlier, and greater awareness of the possibility of brain tumours among clinicians.
	From this unbearable tragedy, however, sprang a determination by Chris and Lisa Green and Danny’s sister, Holly, to support families going through a similar ordeal and to tackle the lack of awareness about brain tumours. For that reason, they set up a charity, the Danny Green Fund, of which I am glad to be a patron. It has gone from strength to strength in supporting families of those suffering from brain tumours, and in particular the debilitating condition of posterior fossa syndrome. It has raised an enormous amount of money for research—in the past two years alone, this tiny charity on Canvey Island has raised more than £160,000.
	Although awareness of more mainstream cancers, such as breast and prostate cancer, has dramatically increased over recent years, and with it funding for research into cures and treatment to improve patient outcomes, it appears that the same level of awareness of, and funding for, brain tumours is not forthcoming. In fact, brain tumours receive just 1% of the entire national spend on cancer research. I find that shocking, considering that brain tumours are the biggest cancer killer of children and adults under 40. Outcomes remain relatively poor, with patients diagnosed with brain tumours having a five-year survival rate of just 18.8%, compared with cancer as a whole, where 50% of patients can expect to survive for at least 10 years.
	Between 1970 and 2010, while cancer survival rates doubled, brain tumour survival rates increased by a mere 7.7%. Rare or not, how can we improve these outcomes for the 16,000 people diagnosed every year with a brain tumour? With more than 120 different types, brain tumours are notoriously difficult to diagnose, and our understanding of other cancers does not readily translate to them. I therefore appreciate that improving outcomes will not be easy, but that does not mean that brain tumours should remain an overlooked cancer.
	Having worked with two excellent cancer charities, Brain Tumour Research and the Brain Tumour Charity, along with two charities in my constituency, the Danny Green Fund and the Indee Rose Trust, I know that the charities are doing an exceptional job in raising awareness about brain tumours and increasing the funding and research to improve treatments. However, I believe I speak for all these charities and those affected by brain tumours in saying that we need to focus on at least four key issues if we are to improve outcomes.
	The first and most obvious area is funding. Brain Tumour Research estimates that to bring research and treatment of brain tumours into line with other cancers and improve patient outcomes, research funding would need to increase to £35 million a year for a decade. We urgently need earlier diagnosis. About 58% of brain cancers are diagnosed in A and E, which is considerable higher than the figure for cancer overall. We need a far better understanding among GPs of symptoms, and better pathways to secure early treatment. Early diagnosis is essential for starting early treatment. As the cancer proceeds, the brain tumours grow, becoming far harder to treat and manage, and for brain tumours, even benign tumour growth, this is potentially fatal.
	New NICE guidelines need to improve the early diagnosis of brain tumours so that more patients are diagnosed by a GP and receive early treatment. We also need a national register of all site-specific cancer research to track the research work, the grants and their results. That is vital, as currently there is not a great deal of transparency in the research field and no clear idea of what research is being funded and results achieved. This leads to confusion, duplication of work and a system that prioritises research in more common cancers, rather than those disease areas of most need, such as brain tumours. A national register would make research more transparent, reduce duplication and allow greater variation in type and scope of research.
	Finally, we need better and easier access to available treatments. Research into new treatments and early diagnosis is essential to beating brain cancer, but more can be done with existing treatments through the NHS. One such example that has been in the news in the last year is proton beam therapy. It is similar to traditional radiotherapy, destroying cancerous cells with beams of high-energy radiation, but it is far better suited to the brain as it only affects the cancerous cells. More widespread centres using this technology could be set up and the therapy given to as many brain tumour patients as possible.
	I hope that some of the issues that I and others will cover in the debate will raise awareness of how outcomes could improve for all cancer patients, particularly brain tumour patients, and put the spotlight on just how deadly brain cancer is in comparison with other cancers.

John Baron: Before my hon. Friend moves too far from the subject of proton beam therapy—something I would have raised had time allowed it—may I suggest that she is absolutely right to raise it? A new generation of technology is coming out of CERN and going to British companies, and we must do our best to at least explore the feasibility of embracing that within the NHS. Not only is it cheaper and better technology, it is smaller, which means that we could have more sites around the country. I know the Minister is aware of this, as we have raised it before, but I hope that it will be addressed in the debate.

Rebecca Harris: This sort of therapy gives great hope to many sufferers of brain tumours in particular.
	The debate is timely for another reason; tomorrow is Danny’s birthday. He should have turned 14, and his family, in his memory, have funded a further day of research with the money they have raised. Mercifully, brain tumours are very rare but, as Lisa Green—Danny’s mum—pointed out, “They are not rare enough when it is your child.” I very much hope that the spotlight can be put on the urgency of improving care.

Grahame Morris: I place on record my thanks to the Backbench Business Committee for allocating time for this timely debate on cancer services. I also thank the hon. Member for Basildon and Billericay (Mr Baron) and the various co-sponsors who made the case for this debate. I also pay tribute to the various all-party groups covering the issues. Many Members are dedicated to particular groups and play an important role in compiling research, getting information to Ministers
	and raising specific issues in Adjournment debates. We should pay tribute to all of those people for all the work they do, irrespective of which party they represent.
	I wish to raise two specific issues; one that, I hope, is not terribly controversial but another—an issue I have raised previously—that I suspect might be. The hon. Member for Castle Point (Rebecca Harris) touched on it as well. I echo the comments of the hon. Member for Basildon and Billericay that we have made excellent progress within the NHS on tackling cancer and bringing forward new treatments and on promoting early diagnosis. But there is still an awful lot we need to do. I get angry when I see reports indicating how badly we are doing in this country at treating cancer patients when looking at international comparators. I know it is difficult because like has to be compared with like and there are issues about centres of excellence. I understand all that, but I think the NHS should be the best in the world. We argue about resources, but the funding should be there to deliver an excellent service.
	The most recent Concord report on the use of advanced therapeutic radiotherapy puts the UK behind in Europe for certain cancers, but also behind Malaysia, Indonesia and Puerto Rico. It says there are a range of reasons why we are falling behind, and one of them is the lack of access to advanced radiotherapy.
	Today, cancer treatment in England is an area of health care where the most money is spent on the least efficient method of treatment. I do not want this to become an argument between the cancer drugs fund and alternative cancer treatments, because they are, in essence, complementary. My concern is that we have taken our collective eye off the ball and have not made sufficient investment in what could, as the hon. Member for Castle Point mentioned, save many thousands or tens of thousands of lives, particularly outside the regions where there is limited access.
	According to the Department of Health commissioning guidelines, radiotherapy cures 16% of all cancers on its own. When combined with surgery, that figure becomes over 40%. I know that my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), on the Opposition Front Bench, has heard all these figures from the Society of Radiographers before, but they are important statistics. In comparison, cancer drugs, which are incredibly expensive—there is a huge outcry if the National Institute for Health and Care Excellence does not approve a cancer drug or if resources are not put into the cancer drugs fund—are statistically very different. If we look at the statistics in a cold and objective way, we find that cancer drugs by themselves cure only 2% of all cancers. The drugs are effective only in combination with other therapies such as surgery and radiotherapy.
	Modern technology has made radiotherapy more effective and much safer for cancer patients. Yet the cancer drugs budget consumes a far larger proportion of the NHS budget in comparison with the radiotherapy budget, which I believe is in the order of £400 million. The disparity is huge because of the requirement to invest in the infrastructure, staff, training, evaluation of techniques and so forth. I personally do not understand how we can make a moral or economic case for not putting greater emphasis on advanced radiotherapy.
	There is, in my view, no better example of unbalanced spending than in this country’s appalling record in delivering SABR—stereotactic ablative body radiotherapy—to cancer patients. This is one of the most precise ways of delivering
	radiotherapy. It is so accurate that it allows tumours to be targeted in a way that was almost impossible 10 years ago, and it can do so without causing harm to healthy tissues.
	I went to see one of these machines in operation. I managed to get one of my constituents referred to a unit in St Bartholomew’s hospital. I saw that the machine focuses a beam—in fact, 200 beams—of intense radiation precisely on to the tumour. This is an incredible development in medical technology. It has the added benefit because of its accuracy, of reducing the number of radiation doses a cancer patient needs from 30 to five. I recall undergoing two courses of radiotherapy like that myself some years ago. That was the standard procedure then; now it is potentially condensed through this advanced form of treatment to five doses. That will be invaluable for older patients. Members have talked about inequalities and how patients over 75 are often unable to access surgery. Perhaps the medical opinion is that they might not stand up to surgery or that conventional radiotherapy might not be an option for them.
	SABR is now used to treat 18 different cancers in the United States. Closer to home, in Europe, it is used routinely in countries such as Italy, Belgium and Switzerland. Its use in France is so well developed that in one centre in Lille the SABR machine is treating 500 patients a year, whereas an identical machine in our country treats fewer than 100. It is all to do with the number of staff who are trained to deal with extended operations. I met a member of the Lille team at a conference in London, and he explained to me how they were able to achieve such a tremendous throughput.
	A recent international survey of more than 1,000 clinicians in 43 countries revealed that 83% of them were using SABR. Only 34% of our radiotherapy centres in the United Kingdom—and it should be borne in mind that we have 28 cancer networks—have the capability to deliver SABR, and nearly all of them use it only for treating lung cancer.
	Five years ago the National Radiotherapy Implementation Group, which consists of some of the best cancer doctors in our country, produced a plan which received extensive support, and which I have raised—not with this Minister, but with her predecessors—during Health questions and Adjournment debates. The plan would allow a wider range of cancer patients in England to be treated with SABR. More importantly, the group recommended that patients should be treated closer to their homes, in centres of excellence. My region, in the north-east, has two cancer centres. Why should your constituents, Madam Deputy Speaker, have to travel from Bristol to London in order to have access to advanced radiotherapy?
	Sadly, that report was ignored—before the present Minister took office, I should add. However, the hon. Member for Wells (Tessa Munt), to whom I pay tribute, has been tenacious in raising the issue since I entered the House in 2010, and, following a campaign by the former England rugby captain Lawrence Dallaglio, which lasted for about two years, NHS England was finally persuaded to start putting it right. The “Dallaglio agreement” will allow our country to start treating cancer patients with SABR and to increase the number of cancers that are treated. It will facilitate the development
	of centres of excellence in the English regions. I certainly hope that we shall have some in the north-east. Those of us who represent constituencies outside London should pay attention to the agreement. We need to ensure that those centres of excellence are created, because they will be able to treat hundreds of cancer patients each year closer to their homes and families, and will have the right technology and staff who are trained to use it.
	However, the Dallaglio agreement is just the beginning. We have a long way to go before we can catch up with our European neighbours. In particular, we need to adapt more skilfully to new technologies as they become available. Quicker adaptation does not mean cutting corners with patient safety; other countries appear to be able to use new technology safely, and to be adapting to it much faster we are. New technology does not have all the answers, but it cannot be a coincidence that countries that adapt speedily to technological advances seem to have much higher cancer survival rates than we do.
	This week, Cancer Research UK said that half of us living today will get cancer. The NHS needs to work out how to deal with that. Cancer is one of the biggest health challenges we face in the 21st century and we need to know that in tackling it we are utilising our valuable resources most effectively. The Government should conduct a full and independent review into the matter, particularly if they are going to spend many billions of pounds on cancer drugs as the best way forward, at the expense of adopting rapid advances in technology, especially robotic technology that is making radiotherapy safer, more efficient and better for patients.
	I would like to address another important matter: end-of-life care and the need to make improvements for people with cancer. Seventy-three per cent. of cancer patients want to die at home but less than a third are able to do so. The palliative care funding review has pointed to the fact that providing free social care is key to supporting people to die at home. Evidence from Macmillan suggests that savings of £345 million could be made. The right hon. Member for Sutton and Cheam (Paul Burstow) will remember the debates that we had. I think we won the argument, although we lost the vote. I sensed that there was a lot of support for free end-of-life care across all parties. I press the Minister to consider that. The Government previously stated that they saw much merit in such a policy. Does the Minister still see merit in the principle of free social care for people at the end of their lives?
	Two further policies are fundamental to improving end-of-life care. The first is the provision of 24/7 community care to ensure that, regardless of what time of day it is, if someone is at the end of their life, they do not have to contact the emergency services to be admitted to A and E. Secondly, there should be better recording of patient preferences at the end of life and better sharing of information between all the services that come into contact with that patient. I support the motion.

Jack Lopresti: I was not entirely sure whether it was a good idea to apply to speak in the debate. It is the first time I have properly put anything on the record about my own experience. I am a cancer survivor. A year ago virtually to the day, I finished about 30 sessions of daily radiotherapy, with oral chemotherapy. It is like awaking from a bad
	dream. I wanted to get on with my life and not look back. Looking back and putting it all together has been quite difficult this week, but the thing that convinced me that I should say a few words was that, apart from support from family, friends and colleagues once I had my initial diagnosis, the most valuable thing for me in getting through the whole thing, keeping my spirits up and being positive was reading, as an inspiration, about people who had been through the journey.
	I ordered tonnes of books from Amazon. I read Bob Champion’s story and re-read the chapter in Rudy Giuliani’s memoirs on beating cancer to give myself as much information as I could about happy endings and going through the process. So I will tell my story, with the message that anyone who is facing the journey, which is very daunting and can be a lonely process, despite the best efforts of friends and family, will get through it. All things end and I am pleased to say that, after I finished my treatment, I was back here within a week or two.
	Within a few months of listening to my friends telling me not to overdo it, I managed to run the Bristol half-marathon and the Stroud half-marathon before Christmas. [Hon. Members: “Hear, hear.”] Thank you. I have just applied to run the first Bristol to Bath marathon in October. That points to a surprising thing. I was always incredibly fit and healthy. I had run my first full marathon nearly a year before my diagnosis. So this can come out of left-field. That is not an excuse for not looking after ourselves, however, because the fact that I had looked after myself and was fit and healthy meant I coped with my treatment better and got through it more easily than I might have done.
	Two years ago in January I had what I thought was the normal annual virus or bug. I thought perhaps I had overdone it a bit at Christmas, so I carried on with the usual paracetamol and got on with things, but eventually, after a couple of weeks, I succumbed and went to see my GP. She was very good and very calm and said, “We’re not quite sure what it is,” but she did refer me quite quickly to my local hospital as an out-patient.
	The staff there said they were worried about me and the fact that I kept flinching when they pressed on my appendix area. They did not let me go home even to get some books and my pyjamas, but my family helped me out. I stayed in for a few days, and the prognosis when the consultant let me go on the Monday morning was that they were pretty certain it was appendicitis but I had an abscess and it could well have hit a cancer. That was the first time I had heard that word. He quickly reassured me that I was far too healthy-looking and it was not very likely, but it was a possibility. They gave me intravenous antibiotics while I was there and sent me home to recover saying, “We don’t normally like to operate on appendixes straight away these days because it is a tricky operation and can be treated with antibiotics.”
	To cut a long story short, this went on for two or three months. I kept finishing the antibiotics, and within about 10 days I would start to feel really ill again. My hon. Friend the Member for Basildon and Billericay (Mr Baron) said to me, “For goodness sake, go back to your constituency and get whatever’s in your body removed because you’re obviously very ill.” I even went to the nurse here at Parliament who said almost the same thing: “I’m very worried. I’m not happy. Get back and get it removed.” But the hospital said, “Oh, it’s a
	grumbling appendix” and kept me in for another week on intravenous antibiotics. Within a week or two of that not working three months had passed, so the initial stages of quick referral and reasonable expectation of what it could be had dragged on for a long time.
	I again recovered quite quickly after the operation, but within a week was due to go back for a referral. I had a phone call in the morning: “You’re coming in to see the consultant tonight?” “Yes, I am. Is that still okay?” “Yes, it’s fine. Bring somebody with you.” That was the first indication that things perhaps were not going to work out. I took my mother, and they gave me the good news. I was being very cheerful because my mother was with me and I said, “The only thing I really want to know is can you sort it?” “Yes,” was the answer, so I was fine. “And can we get on with it?” I asked right away, and they did, in fairness. I started six cycles of chemotherapy over three months, which I got through relatively easily because of my health and my natural optimism.
	I remember doing gardening for the first time in my life and planting a fig tree in my garden, and thought things were progressing quite well. Colleagues sent me books. My hon. Friend the Member for Bristol North West (Charlotte Leslie) sent me some poetry which was really nice of her and I will always be grateful. So that period passed well, and I had cracked it in my own mind: I was in that place, and I was moving forward.
	Then, on 17 September, after a sort of debriefing appointment to ask me how I felt and how I was getting on with things, I had a letter which said: “I saw Mr Lopresti today in clinic. He has chosen to stop his chemotherapy after three months and so has completed treatment.” I thought to myself, “That conversation never took place,” and started to question myself and wonder whether I had heard correctly. Fortunately, I then had a consultation with the oncologist who said, “You will have six rounds of treatment over three months.” For the first time in my life I did not question instructions: I did as I was told. Actually, I am very impatient, and I just wanted to get on with it and get on with the next stage of my life, but I had started to question whether I had heard that correctly.
	I thought about what had happened and spoke to my mother and my wife who had been there. They said, “Yes, they said, ‘It hasn’t spread, we’re going to cure it, and we’re going to give you six rounds.’” So I made a complaint. I said, “This has knocked me back probably almost as much as the original diagnosis,” because it shatters confidence in getting straightforward, reasonable, objective analysis and projections of treatment. I also thought, “What would have happened if I was an older person on my own and feeling quite vulnerable?” The apology I received explained that it was because a randomised control was being carried out and they were trying to work out whether giving somebody six rounds in three months was as good as 12 lots in six months. That is fine, and as it turned out my next scan was clear—as have been all my scans, so I am in good order. If they had told me, “You are relatively young and fit. You don’t need 12 lots because it can damage the nerves and there are long-term consequences”, I would have been okay with that, but in fact a conversation that did not take place was recorded and they wrote to me about it. I started to think, “If they can make a mistake on this, what else have I discovered?”
	So I had the apology, and I went back to see my consultant. He said to me, “I have really good news. Your scan is clear. You are fine. We can just keep an eye on you or you can have some radiotherapy.” I said, “Look, given what has gone on, I want everything you’ve got. Whatever you’ve got, let’s do it once, get it done. I do not care if you have to carry me out of here, let’s try to get it first time.” In fairness, they did that. I had daily radiotherapy, which surprisingly was more debilitating and took more of my energy than my long course of chemotherapy. I think that was because it was daily and because of the way radiation reacts on the body.
	As hon. Members have said, early intervention is, obviously, key. The referral to the hospital was done quickly in my case and was great. The problem was that three-month delay, when a tumour about the size of a fist was in my body Fortunately, the cancer had not gone anywhere else, but I had a very lucky escape. It could have moved and gone elsewhere, and we could be having a different conversation. I agree that early intervention is key and people should get off to the hospitals quickly, but if there is any suspicion that something is cancer, people have an obligation to get on with dealing with it as quickly as possible, for all the obvious reasons.
	I received great medical support and care from the nurses—the people at the sharp end, the people in the wards, the people who did my PICC line—but I felt slightly detached from the consultants. As I say, the experience of a letter completely misrepresenting an interview that took place was shattering and it shredded my nerves for quite a time. I am pleased that the Government have been working to achieve earlier diagnosis of cancer and to set up a strategy to save 5,000 lives by 2015. The latest projections are that, as a result, the NHS is on track to save an extra 12,000 lives each year. That is all fantastic.
	What I wish to say in conclusion—I apologise for my emotion—is that when someone gets the diagnosis, they have to stay focused and stay as positive as they can. There are lots of help groups, such as Macmillan—

John Baron: I commend my hon. Friend for the bravery he has shown, not just in how he dealt with his complaint, but in sharing his journey with the House, because nothing is more powerful than hearing personal testimony. He illustrates better than anybody in the Chamber will do today the importance of good communication and consultation between patients and the NHS and the consultants. For me, at least, that is the key message he is portraying. It is terribly important, and I hope all of us and, in particular, the NHS learn from it.

Jack Lopresti: I thank my hon. Friend for his kind remarks, which I shall not dwell on. You do become, if not an expert, certainly quite knowledgeable, and are introduced to the cancer world. There is a lot of information out there. I was told by some consultants not to spend too much time on the internet, as you can go down different avenues and worry yourself to death, but there are lots of good books. I would recommend talking to Macmillan and other cancer groups, reading others’ stories, being inspired and being motivated. You should never lose heart.

Bob Stewart: Will my hon. Friend give way?

Jack Lopresti: I had finished—

Bob Stewart: I will finish for my hon. Friend. This is a very brave man, because he wants to join the Royal Air Force. He is fully fit, he does marathons—he is a lunatic of course—and he wants to join the Royal Auxiliary Air Force, whose tie I am wearing in support of his bid.

Eleanor Laing: Order. I am sure I should reprimand the hon. Gentleman for suggesting that the hon. Member for Filton and Bradley Stoke (Jack Lopresti) is a lunatic. That is not parliamentary language, although I am sure it was meant in a kindly fashion. He was, however, absolutely right to commend the hon. Member for Filton and Bradley Stoke for the very brave speech that he has just made, which the House seriously appreciates.

Paul Burstow: Thank you, Madam Deputy Speaker. I wish to echo that very point. Some of the best debates that we have in this House, and certainly some of the best Back-Bench Business debates, are ones in which people bring their own personal experience and their own stories. My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) talked about the stories that gave him inspiration and hope. I hope that people listening to this debate will gain inspiration and hope from what he has said today. I hope, too, that those who are responsible for planning and commissioning our services and for training our medical professions gain insight from it.
	We talk a lot about the concept of shared decision making, and my hon. Friend has demonstrated where that can work well and where it can fall apart. When it falls apart, the impact on the person concerned is immeasurable. I am really grateful to my hon. Friend for his unique and important contribution.
	I also thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tenaciously pursuing not just the opportunity to have this debate but this whole issue. It is undoubtedly the case that, when it comes to cancer, he has been there championing the cause. When I was a Minister, I had plenty of occasions to feel the effects of his championing. I always appreciated the way in which he pursued the matter, and I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has experienced that as well. He is always civil, always polite, but relentless in pursuing what he wants to achieve.
	In this particular week, when we have marked world cancer day and had the news from Cancer Research UK that one in two of us are likely to experience cancer in our lifetime, it is absolutely right that we should be debating what more we need to do to go beyond the ambition of this coalition Government to save lives and to achieve the ambition that we set for the NHS in the next Parliament.
	Part of the news that sits behind that one in two figure is the fact that we are living longer. I want to caution against the notion that, in some way, living longer is some sort of curse—all too often it is portrayed in that way—and that we should be worried about it. The other thing behind that research is that those
	cancers that may occur in later life are not inevitable. There are things that we all can do if we make choices about the lifestyles that we lead—whether that is quitting smoking or losing weight. When one considers that there are still 100,000 deaths a year due to smoking and that two thirds of people who are addicted to smoking become addicted before the age of 18 it is clear that we need to focus quite rightly and relentlessly on issues around prevention as well. That is why we should celebrate the news that, just yesterday, the Minister successfully took the regulations through this House that will result in a ban on smoking in cars where children are present, which will make a difference. We have an assurance from the Minister and the Government that, before the end of this Parliament, there will be a vote to have standardised packaging, which will be a real step forward in dealing with the issues of the impact of smoking.
	We must do more to tackle smoking, especially in the context of mental health and mental health services where the prevalence of smoking is so much higher. There are examples of good mental health services that have found ways to reduce smoking. None the less, there is a significant difference in life expectancy between people with severe and enduring mental health problems and people who do not have such problems.
	Some reference has already been made to the health inequalities with regard to ageing, and I will come back to that. We need to recognise that there is a broader issue around the social gradient. If someone is poorer, they are more likely to be at risk from cancer, especially when lifestyle is a factor. The strategy that is being drawn up by the taskforce needs to address the whole range of health inequalities to deliver on the challenge that was rightly set and the duty that was imposed on the NHS to tackle health inequalities under the Health and Social Care Act 2012.
	Sean Duffy, the national clinical director for cancer, has said that our cancer survival rates are at an all-time high, and my hon. Friend the Member for Basildon and Billericay set out the statistics that show why we should celebrate the progress that has been made over a number of years. Clearly, if half of us will get cancer during our lifetimes, we must keep looking afresh at what more we can do. That is why the announcement of the taskforce in January to look at what the next five years should hold for cancer work is absolutely right. We cannot rest on our laurels.
	Again, I pay tribute to the hon. Member for Easington (Grahame M. Morris) for tenaciously pursuing the case for radiography, just as my hon. Friend the Member for Wells (Tessa Munt) has done, and I give him due respect for doing so. The strategy that is being developed must answer the concerns that he and other hon. Members have been raising for a number of years. The ability to combine different innovations—whether pharmacological or technological—is absolutely key to how we catch up and then stay ahead in terms of cancer survival rates, and it is why we need this ambition of going beyond just achieving the average cancer survival rates in Europe to strive to become the best in Europe. Better prevention, swifter diagnosis, better treatment and aftercare are all part of that.
	On early diagnosis, we have heard that a quarter of diagnoses or thereabouts take place at an emergency stage—far too late—and the outcomes are bad as a
	result. Therefore, we need a clear commitment to fund the Be Clear on Cancer campaign throughout the life of the next Government, because awareness raising and the identification of signs and symptoms make a difference. For example, in the areas where the lung cancer signs and symptoms campaign was tried initially, 700 extra patients were diagnosed—700 people had an opportunity to live their lives longer as a consequence.
	The hon. Member for Washington and Sunderland West (Mrs Hodgson), who, again, is a tenacious pursuer of ovarian cancer issues, is absolutely right to ask why, on the basis of the pilot evidence from 2013, we are not pursuing ovarian cancer in the Be Clear on Cancer campaign. I hope that the Minister will answer that and perhaps give us the prospect of good news. The hon. Lady certainly persuaded me when we took the decision to hold the pilots, and I would want to know why we should not pursue it. Certainly, the pilots that she referred to suggest that there is good cause to do just that.
	I was struck in preparing for the debate by the research published by Cancer Research UK looking at what could be achieved with earlier diagnosis if we strove to eliminate inexplicable variations in England. In other words, if we had diagnosis rates at the best level just in England everywhere—for colon, rectal, ovarian and lung cancer—it would benefit 11,000 patients and save the NHS £44 million. If we could do that for all 200 cancers, it would help 52,000 people. It is within our grasp to do massively more if we learn just from the best in our own country, let alone striving to be the best in Europe, which we would become if we did that. I very much welcome the work that CRUK and Macmillan are doing with NHS England to deliver that.
	My hon. Friend the Member for Basildon and Billericay talked about the unacceptable cancer death toll among older people and the over-reliance on chronological rather than biological age in making judgments. As the then Minister who took the decision that there should be no exemptions from the equality duty with regard to age discrimination for the NHS, I think that that is not acceptable. Chronological age should not be used; the person and their individual circumstances should be considered in judging which treatments should be available.
	It is therefore also vital that we recognise that in later life, because of complex comorbidity and frailty, there are additional needs, sometimes social needs, that are not properly taken into account. While I was the Minister with responsibility for cancer, I was pleased to help launch the work that Age UK and Macmillan were doing to pilot new ways of ensuring that more older people would gain access to cancer treatments. It would be useful if the Minister could say where that has gone and whether it will be continued. I hope the work will be looked at when the taskforce draws up its strategy.

John Baron: As a Minister, the right hon. Gentleman was always a great champion of cancer. One accepts the complexity arising from comorbidity, but does he believe that the under-75s cancer mortality rate indicator should be looked at again as a means of helping to redress the issue?

Paul Burstow: Personally, I think that at some point there must be a legal challenge as to whether that places ageist assumptions at the heart of the NHS. The fastest
	growing part of our population are the over-85s. How on earth can it be that we do not have statistics that allow us to know how well that older part of our population is being treated for cancer, let alone anything else? When one considers that when the NHS celebrates its 100th birthday, there will be over 100,000 centenarians in this country, it is clear that we need to start catching up in the way in which we use data to ensure that we are not discriminating inappropriately on the basis of the person’s date of birth. I agree that the indicator needs to be looked at.
	The hon. Member for Easington also mentioned the cancer drugs fund. After the election there should be a thorough evaluation of the impact of the cancer drugs fund over the past five years. It was a good initiative; it plugged a gap, but unfortunately the gap that it was plugging is now not being filled because there has not been a change in the way we pay for drugs. It could play a part in underpinning combinatorial innovation of the sort that the “Five Year Forward View” mentions.
	On the hon. Gentleman’s reference to free end-of-life social care, I have not changed my view. When I wrote the care and support White Paper, we made it clear that we saw much merit in free end-of-life social care. Because of the reports that have been published since, I believe that the evidence has grown even more compelling that this is not a cost to the NHS. It would be a benefit to the NHS. I know that my right hon. Friend the Minister of State who has responsibility for care and support has taken that view as well, and I hope we can see progress on that too.
	As the Member of Parliament for Sutton and Cheam, it is a source of great pride to me that I live in a constituency which has a hidden gem—the Institute of Cancer Research. As I am sure hon. Members in all parts of the House know, that is a world-beating research facility, taking research and discovery from the lab to the bedside in collaboration with the Royal Marsden hospital, which is on the same site—a phenomenal site which is looking to expand further. It does fantastic work, including genetic testing, which is an area that I want to raise with the Minister.
	The institute has been a pioneer in mainstreaming genetic testing, particularly around BRCA 1 and 2. It has developed a good practice model that can mainstream genetic testing into existing oncology appointments. The potential of that is amazing—four times the volume of activity can be delivered through this new pathway at twice the speed and half the cost. In other words, we can gain the benefits of genetic testing without apparently having to spend more money, but delivering much more targeted and insightful diagnosis and onward treatment as a result. That pathway exists. It has been developed, refined and tested, but it has not yet been widely adopted, despite the fact that it is freely available. I wonder what more could be done to make sure that it is more freely adopted. Perhaps the Minister could say how the strategy might help take that forward.
	This debate needs to be set in a broader context. If we are to achieve an ambition of matching the best in Europe over the life of the next Parliament, we must address the funding pressures that are acknowledged in the “Five Year Forward View”. This Government have started to acknowledge that with what Simon Stevens
	described as the “down payment” of the £2 billion announced in the autumn statement, which will come in from this April, but we know that we need to give the NHS certainty about funding for the life of the next Parliament.
	All of us who are responsible for articulating different party points of view on health policy need to be clear with the NHS and with the public about what we would do with regard to funding. I am therefore pleased that the Deputy Prime Minister and the care and support Minister have set out how the Liberal Democrats would provide the £8 billion requested in the “Five Year Forward View”. I look forward to the debates we will have over the coming weeks on how others would achieve the same thing, which we need. This debate, however, is an important way of shining a light on the progress that has been made and the opportunities to make further progress.
	I thank the hon. Member for Basildon and Billericay for securing the debate and the Backbench Business Committee for allowing it. This is what it makes clear: yes, there has been progress, but there is still much more to come.

John Glen: It is a great pleasure to contribute to this important debate, because so many of our constituents are eager for us to grasp the underlying issues relating to cancer, to explore how to deal with the inadequate service they sometimes receive, and to address some of the challenges we will face in future. As has been mentioned, Cancer Research UK said this week that one in two people will be diagnosed with cancer. As we heard in the moving testimony from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), sometimes that diagnosis comes out of the blue; it is random and unrelated to previous medical history. We need to recognise that, but we also need to look at the public health challenges. I will therefore focus my remarks on two points: first, the important role that public health has to play; and secondly, how we can ensure that patients have access to timely diagnostic procedures, regardless of where they live.
	Four in 10 cancers are thought to be preventable, which is why it is crucial that we view prevention as one of the best cures and work relentlessly to pursue what is required to reduce the number of people who suffer from cancer. We need to work at changing attitudes to prevention across the population, and keep pressing the message that cancer is not always a disease of chance. The 2011 strategy rightly placed an emphasis on that and on delivering a “whole society” approach. In my constituency, NHS nurses run an excellent annual fair to raise awareness of the link between cancer and factors such as smoking, diet and lifestyle. That proactive initiative by a group of local nurses offers a targeted solution. It is combined with clear national campaigns, such as the successful Be Clear on Cancer campaign, which enable us to reach as many people as possible.
	I become very weary when Ministers bring forward sensible measures for dealing with some of the drivers of cancer, only to hear an outbreak of great ideological proportions about what we should be doing. It is undoubtedly critical that we continue the vital research into new treatments, but we must also remember that
	reducing the prevalence of smoking in the UK by just 1% could prevent 3,000 cases of cancer a year. I therefore welcome the decision to introduce standardised tobacco packaging, at a time when around 600 children start smoking every year. I welcome that on the basis of evidence and as a pragmatic decision, but I also want to challenge the assumption that somehow everyone has a free choice about whether to start smoking. I think there are many communities, in my constituency and up and down the land, where peer pressure to start smoking plays a crucial role. If there is anything we can do to reduce the attractiveness of smoking—which we know is so addictive and distinct from other health pressures—we should get on and do it.
	Next, I want to highlight the crucial role of GPs. They are the gateway to wider diagnostic and treatment services, and we need to invest in them. We must invigorate their leadership and role in guiding patients to healthier lifestyles and earlier diagnosis, and therefore to earlier treatment and better outcomes. In 2011, as part of the cancer outcomes strategy, the Government provided £450 million of funding to help GPs access diagnostic tests earlier. The benefit of this investment is clear and will save about 12,000 extra lives every year. However, there are significant inequalities in referrals for diagnostic tests. There is a ninefold variation across GP practices in referring patients for the CA 125 test to identify ovarian cancer, and a fivefold variation in referrals for the PSA test used to identify prostate cancer. I visited a group of GPs in my constituency who were somewhat frustrated when they read the comments of the Secretary of State about wide disparities in diagnostic rates. However, this is not about criticising GPs but about recognising that we have unacceptable differences across the nation. NHS England has proposals to enable patients to self-refer for tests, and to establish multi-disciplinary diagnostic centres that allow patients to have several tests done at once. Those are welcome steps, as is the commitment from the Chancellor in the autumn statement to increase the proportion of funding allocated to GPs.
	I pay tribute to the work done by charities across the UK to raise awareness and funds for research—in effect, to carry out life-saving interventions to ensure that even when forms of cancer are very rare, the best possible treatment is accessed. I know from my own modest experience—last week I was a blood stem cell donor—that Delete Blood Cancer UK, the Anthony Nolan Trust, and Love Hope Strength do an enormous amount of work to find matches for patients with blood cancer. On 17 March, we will hold another recruitment event in the House to get more people registered. I commend that to all Members present and to all colleagues. Only half the people in this country who have blood cancer find a match, so we can make a small contribution in that way.
	I will conclude by focusing on a concern that I have deep inside me whenever we have a debate on the NHS. The fundamental dynamic is one where the supply of treatments and new procedures is ever growing, people are living longer and longer, and demand will increase. Everything we talk about relies on more money going into the NHS, whether that is more transparency, greater awareness of what cancer rates exist across the country in one year, or how we can differentiate the quality of outcomes for 85-year-olds and 65-year-olds. Wherever we know that inequalities and differences exist, there will be yet more pressure to fund more services and
	more work. We can try to counter this through bigger public health campaigns and greater awareness of how to live—how not to eat, smoke or drink too much—but we also need to be honest about what the NHS can tolerate in this never-ending dynamic of increased supply of services, increased demand, and increased expectations. The right hon. Member for Sutton and Cheam (Paul Burstow) talked about our coalition partner’s commitment to put up £8 billion, and he welcomed the fact that there will be £2 billion more from April.

Paul Burstow: The hon. Gentleman is making the important point that we must debate the resourcing of the national health service. I made the point that removing inexplicable and unfair variation in access to early treatment for cancer will not cost more, but will save money.

John Glen: Absolutely, and I was going to come on to that. My fundamental point is that we must change the appetite of the nation for the NHS. Yes, we want it to be there when random events take place, but we must also recognise that if we are to promote better health, everyone in this country has a responsibility as individual citizens to reduce the demands on it. Unless we do that, every five-year forward view will imply further and further increases. We need to be realistic about the fact that, unless we make real changes, we as a country will be presented with profound challenges.

John Baron: My hon. Friend is making a thoughtful and powerful point, but may I push back very gently? For me, the most transformational improvement we could make would be to put the one-year figures up in lights, as I said earlier. That will not cost money; it is about our sense of priorities, as he is fully aware. When we consider that we spend almost as much money per head of population on our health care system as many continental countries, but are still 5,000 lives behind the average—let alone 10,000 lives behind the best—there are still vast improvements to be made within existing resources, and those improvements would save money.

John Glen: I absolutely take that point, but I am challenging the fact that it is extremely demanding to deliver structural changes to how we provide the volume of services in a national system. For 18 months, I went through the experience of dealing with Naomi House, which provides palliative care for children and serves Hampshire, Berkshire and Wiltshire. I met four Ministers and the Prime Minister, but we still did not get a concession on bringing forward guidance on the use of tariffs by local authorities supporting palliative care for children. It was a case of being told that there would be a review, which would happen this year, next year or whenever. Because of my great frustration that delivering this change demands such effort, I doubt that continuing with the NHS as it is now will ever satisfy people. We must be more nimble in dealing with such challenges.
	The other outstanding issue relates to the use of data. My hon. Friend the Member for Basildon and Billericay (Mr Baron) rightly pointed to the need for more awareness of data transparency so that we can target resources more effectively. I hope that he is right about the sufficiency of the resources that every party in the House will no doubt pledge in the run-up to the general election. However, when we have a lot of data, we need to be able to process and deal with it, and ensure that we use it to
	guide resource allocation decisions. I resist strongly all the voices saying that we need to be extremely cautious about using data. Unless we can aggregate data on health outcomes in different dimensions, and use them to drive the reallocation and refocusing of resources, we will not deal with inequalities.
	I have probably said enough, but I want to thank my hon. Friend who has given us all something to aim for by championing cancer issues. I once again commend the recruitment event pushed by my local paper in Salisbury, the Salisbury Journal, to make us the place with the highest number of people on the register of Delete Blood Cancer UK. Will the Minister reflect on the key point about the sufficiency of resources and the challenges that the NHS faces and give us an honest answer, as I know she will? It is really important that people outside Parliament know that Members understand the challenges involved in the vital area of how to tackle cancer.

Andrew Gwynne: I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate and on the considered way in which he set out the issues in his opening speech.
	I thank my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Easington (Grahame M. Morris), the hon. Member for Castle Point (Rebecca Harris), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Salisbury (John Glen). I have not left out the hon. Member for Filton and Bradley Stoke (Jack Lopresti), but have left him to the end. I pay special tribute to him for the moving way in which he shared his personal experience. His message will have offered hope and inspiration to people who are listening to this debate. I thank him especially for that.
	I extend my thanks to the Backbench Business Committee for ensuring that this debate could go ahead. It is crucial that when we mark important events such as world cancer day, the message goes out from this House of Commons that, whatever our political differences on whole areas of public policy, including the national health service, when it comes to matters such as our commitment to tackling cancer, we speak with one voice.
	It is a particular privilege to take part in this debate on behalf of Her Majesty’s Opposition. From the outset, I want to echo the proposer of the motion in paying my own tribute to the various cancer all-party parliamentary groups, which do such good work to highlight these issues in Parliament. Cancer care and prevention is one of the most important policy areas for politicians to consider.
	When I was a teenager, my mother was diagnosed with ovarian cancer. I would like to say a personal thank you to my hon. Friend the Member for Washington and Sunderland West for the work that she does on ovarian cancer. Despite my mother paying numerous visits to her GP in the months before she was diagnosed, the cancer was not picked up until a later stage. As my hon. Friend described, although the symptoms were
	there, they were put down to other factors such as heavy lifting at work. By the time the cancer was diagnosed, it was too late for treatment to be effective and my mother passed away in hospital when I was 19. Not a day goes by that I do not miss her. Not only was I robbed of my mother; my three children missed out on a pretty fantastic grandmother. I therefore understand the very personal hurt that a loss from cancer can cause.
	I do not blame the GP for not spotting my mother’s cancer. As my hon. Friend the Member for Washington and Sunderland West set out, patients with ovarian cancer often present with symptoms that are not easily recognisable. However, it did make me question what more could have been done. That was in 1994. In the 20 years since, we have made huge progress in improving cancer services. In the last decade, five-year survival rates improved for nearly all types of cancer. However, as we heard in the opening contribution of the hon. Member for Basildon and Billericay and in the speeches of other hon. Members, we still lag behind other countries.
	There is worrying evidence from the past five years that the progress that we have made on cancer care has stalled to some extent. People are waiting longer for vital tests and the national cancer target has been missed in the past three quarters. Over the past four years, cancer spending has been reduced by £800 million in real terms. It is worth saying that in government, Labour created 28 cancer networks to drive change and improvement in cancer services. Those networks brought together the providers and commissioners of cancer care to plan and deliver high quality cancer services in their areas. They helped to oversee and drive up the quality of services that were delivered to cancer patients. By significantly changing their structure and reducing their budgets by millions, as well as by scrapping the highly regarded national cancer action team, I would argue that the Government have disrupted those networks.
	Cancer Research UK published an analysis late last year that suggests that cancer services have been weakened by the shake-up of the NHS. It also suggested they lack the money to cope with the fast growing number of people getting the disease. The charity found that real-terms spending on cancer reached a record high of £5.9 billion in 2009-10, but since then it has declined to £5.7 billion in 2012-13. So not only has the money been reduced, but the delivery mechanisms, which helped share expertise and best practice, have been dismantled.
	Our hard-working clinicians and staff are trying their best within the system, and despite the challenges, continue to deliver quality care, and we should all recognise and pay tribute to the work that they do across the NHS. Let me come on to what we would do were we in government. We have made a commitment that within the first six months of the election, the next Labour Government will publish a cancer strategy with the goal of being the best in Europe on cancer survival. That would include increasing the rate of cancers diagnosed early, which—as we have heard in this debate—drastically increases the chances of survival. At the moment, just over half of cancers are diagnosed at an early stage, but over the next 10 years, we want to see that increase to at least two in every three cancers. If the benchmark of today’s best performing areas—60% of all cancers being detected early—were met across the country, it would mean 33,000 more cancers diagnosed early each year by 2020.
	We also plan to make leaps forward on screening and diagnostic tests. We have announced that we will put an extra £750 million of investment into testing over the next Parliament. That will enable us to guarantee a maximum one-week wait for tests and a one-week wait for results by 2020. That will be the first step towards achieving one-week access to key tests for all urgent diagnostics by 2025. That will be made possible by new investment, paid for through a levy on the tobacco industry, because it is only right that those who make soaring profits on the back of ill health should be forced to make a greater contribution in that area.
	We will also ensure that the new bowel scope screening programme is rolled out by 2016, which I know will please the hon. Member for Basildon and Billericay. Research has found that patients who are able to see their GPs within 48 hours are less likely to have their initial cancer diagnosis via an emergency hospital admission.

John Baron: The whole cancer community has been behind the all-party group on cancer and the cancer-specific all-party groups in pushing for the one-year survival rates to be broken down by CCG and put on the delivery dashboard. The shadow Secretary of State welcomed that development when he spoke at the Britain Against Cancer conference in December. I do not intend to make predictions about who will win the general election during this debate, but may I press the hon. Gentleman–I am pressing my own side—to ensure that if Labour wins it will attach as much importance to the one-year figures and pursue those CCGs that are underperforming, in order to drive forward initiatives at a local level that encourage earlier diagnosis, as I know my party will do, once returned.

Andrew Gwynne: I absolutely agree with the hon. Gentleman. In fact, my right hon. Friend the Member for Leigh (Andy Burnham) has given that commitment as shadow Secretary of State. We need to make sure that if CCGs are not performing as well as they could be in this area, Ministers and NHS England take every action they can so that we bring standards up and everyone can expect the same level of treatment, irrespective of which part of England they live in.
	The right hon. Member for Sutton and Cheam is not able to be here for the winding-up speeches but, as a courtesy, he let both Front Benchers and the proposer of the debate know that he would not be able to be here. He was right to raise the issue of long-term funding for the NHS. I do not think it is appropriate to talk in a knockabout fashion in this debate about who is going to raise what or when, but Labour has committed to the new time to care fund, which will enable us to have 8,000 more GPs by 2020. That, undoubtedly, will help to improve access and ensure that doctors get more time with their patients.
	At the moment, fragmented primary care makes it more difficult for patients, particularly the elderly, to see one doctor who can develop a long-term view of long-term complex conditions. That is why, alongside our commitment to guaranteed GP appointments within 48 hours, we have made an equally important pledge to ensure that patients can book ahead with a GP of their choice.
	Honourable Members may also have heard that Labour wants to work with the Teenage Cancer Trust to expand
	its cancer awareness programmes across all schools in England. Too many young people leave school without knowing the warning signs of cancer. Every young person should have the opportunity to learn more and know where to go if they are worried about their health. We in this place, on both sides of the House, owe it to our young people to teach them the signs of cancer and it is just as important to build their confidence so they can seek help. Early diagnosis, as we have heard, is critical to improving cancer survival, because treatment is more likely to be successful at an earlier stage. I commend the hon. Member for Castle Point for her powerful contribution today, and for the work she is doing in her constituency along these lines to make sure, working with those charities, that young people are more aware of the symptoms of cancer and where they should go if they exhibit signs of ill health.
	When doctors catch bowel cancer at the earliest stage, more than nine in 10 people survive for at least five years. At the moment, however, fewer than one in 10 people with bowel cancer are diagnosed at the earliest stage. Many Members will be aware of the appalling statistic that a quarter of cancer cases in England are currently diagnosed through an emergency route. Naturally, far too many of these cases are in the advanced stages, meaning the prognosis is poor compared with cancer diagnosed through other routes.
	Late diagnosis is not just worse for health outcomes; as we have heard, it can cost more too. The average cost of treating stage 1 colon cancer is about £3,400, compared to £12,500 at stage 4. Analysis by Incisive Health found that if all CCGs were able to achieve the level of early diagnosis of the best CCGs—our long term target—then across all cancers we would be making annual savings in treatment costs of about £210 million. That touches on the points made by the hon. Member for Basildon and Billericay, as well as by the hon. Member for Salisbury and the right hon. Member for Sutton and Cheam.
	The hon. Member for Salisbury also touched on the postcode lottery for diagnostics and treatments. He is absolutely right. With the leave of the House, I would like to talk about a case from my early time as a Member of Parliament, back in 2005. I have the privilege of representing a cross-borough constituency, so I have two of everything. I have two local authorities and two police divisions and so on. Back then, there were two primary care trusts. My constituent came to my surgery having been diagnosed with breast cancer. Her doctor had decided that the best treatment for her was Herceptin. If she had lived in the other part of my constituency, the primary care trust responsible would have provided Herceptin treatment for her, but because she lived on the other side of a road, with an invisible line down the middle, she was not able to access that treatment. It was one of those moments where it was appropriate for the MP to throw all his toys out the pram, and thankfully the PCT changed its decision. One of my nicest moments as an MP was about two years ago when the lady, who I did not recognise, came back to my surgery with a completely different case. At the end, she said, “Mr Gwynne, you don’t recognise me, do you?” I looked blank, and panic-stricken, because we deal with so many constituents, and she said, “I’m that lady you got herceptin for. I’m still here.” It was one of the proudest moments of my time so far as an MP.
	That brings me to our plans for treatment. We have pledged that a Labour Government would continue to work with the cancer drugs fund, but we also recognise that the fund unreasonably excludes other advanced treatments. This takes up the point made by the hon. Member for Castle Point and the firmly and long-held views of my hon. Friend the Member for Easington. For that reason, we would expand the cancer drugs fund to include other treatment options, such as radiotherapy and surgery—the two treatments that together are responsible for nine in 10 cases where cancer is cured. That point has been powerfully made by my hon. Friend on so many occasions—it is still ringing in my ears.
	The nature of cancer is changing. Just as with AIDS, rapid advances in technology mean that cancer is no longer the death sentence it once was, and this welcome change means that cancer is increasingly considered a long-term condition, which brings its own requirements, in terms of long-term care and support. A report from the King’s Fund suggested that as cancer survival rates improved, health care services needed to improve the quality of life of the growing number of people with cancer. The needs of cancer patients often span every tier of care in our system, yet it often proves incredibly difficult to navigate the various systems. We therefore plan to give everyone with the greatest need a single point of contact. This person will be their co-ordinator and advocate in the system, identifying their needs and ensuring they are met. No cancer patient should end up lost in our vast health system, unable to find the treatment they are entitled to.
	Cancer survivors have to be properly supported once their treatment stops to help their recovery and minimise the impact of their illness on their overall health. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service will not cope with the growing cancer population. We owe it to families battling cancer to continue to have high ambitions. In that spirit, Labour has set out its plans for improving early diagnosis and expanding access to new innovative cancer treatments. I thank all Members for their contributions. Despite our many political differences, we have the same ambition for cancer—to bring forward the day when this terrible disease is beaten.

Jane Ellison: It is a pleasure and an honour to respond to an excellent debate in which we have heard distinguished contributions from both sides. This is the sixth debate in six months I have responded to on cancer, which demonstrates the House’s interest in this important subject. I congratulate the all-party groups on cancer, not only on securing this debate, but on everything they have achieved—I will touch on that at the end of my remarks. I sometimes think that with the expertise we have between us, and given the number of times some of us have met in these debates, were we not to be returned to this place, we could take our cancer awareness roadshow around Britain and do some good for the nation in another way.
	I shall try to respond to as many points as possible, and in some areas, I can update the House. However, I want to rattle through as many of the detailed points as possible, and I am sure that the shadow Minister, who I like very much, will forgive me if I do not counter his reiteration of the Opposition’s policy position with a detailed exposition of the Government’s. I will say only three things. First, I shall respond mostly to the Back-Bench contributions. Secondly, I do not recognise his figures on reduced spend, although I understand from where they are derived. Thirdly, when the NHS is bringing together its own strategy on cancer, I would question why we would want to come forward with another strategy. As the hon. Gentleman and others have argued, there is a remarkable degree of consensus about what needs to be done and that is the area we need to focus on.
	Obviously, improving cancer outcomes is a major priority for the Government. As the annual report on our outcomes strategy showed in December, we estimate that we will save an extra 12,000 lives a year by 2015, more than double the ambition of 5,000. That figure of 12,000 lives is the best estimate based on a projection using the latest survival estimates and assuming incidence is constant, which I think responds to points made in the debate. I am sure that my hon. Friend the Member for Basildon and Billericay (Mr Baron) will be interested to see the detailed breakdown of how that figure is derived in the annexe to the fourth annual report on the cancer outcomes strategy.
	Clearly that figure represents a great achievement by the NHS and it is good news for the thousands of people affected by cancer. Yesterday was world cancer day. A number of Members have referred to the one in two figure. I emphasise that, in the bylines to that headline, it made the point that that was only if lifestyle factors for many people were not adjusted. In fact, chances are considerably better if we could make some of those lifestyle changes. That was alluded to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who as usual made a distinguished contribution. I know that he could not stay for the winding-up speeches.
	My hon. Friend the Member for Salisbury (John Glen) made well a point about prevention. Were it not unparliamentary, I might have run up the green Benches to embrace him when I heard his argument in favour of tobacco control and standardised packaging. I could not agree with him more. It was absolutely excellent. The “Five Year Forward View”, which many Members have talked about, is the NHS’s vision of its future strategy. It was brilliant to see prevention right at the heart of that strategy; there is an entire chapter about it. Picking up the point made by my hon. Friend the Member for Salisbury, I have discussed this issue with all the major charities over the past six months and asked them to bring their considerable reach and influence to bear and to talk as much about prevention, given their authority on treatments and drugs. That is an ongoing conversation and we have seen some evidence of that. My hon. Friend is right to remind us that 80,000 people a year die in England as a result of tobacco. If only the women in the 1970s who started smoking knew what we know today; it is now two weeks since lung cancer took over from breast cancer as the
	biggest killer of women. We continue with our tobacco control measures with enthusiasm. We have a good record.
	Of course we want to match the best in Europe, and there has been some discussion about that. We accept that cancer survival in England has historically lagged behind the best performing countries in Europe and the world. However, none of those international comparisons of cancer survival includes patients diagnosed after 2007. I delved into this matter in anticipation of the debate. We always cite the figures, but the reality is that because of the time lag, the five-year survival rates are essentially the gold standard—the benchmark against which the international comparisons are made. Therefore, because of the time lag in the five-year survival rates, we are not in a position to know exactly how we are doing compared with other nations.
	However, I take the points made often and well by my hon. Friend the Member for Basildon and Billericay about the one-year survival data. It is inaccurate at the moment to use those figures based on patients diagnosed before 2007 as a measure of current performance in the system. The next best estimate of international benchmarks will be in 2017-18. Until then we will look at issues such as projection.

John Baron: May I seek clarity on that? Is my hon. Friend saying that the 2007 figures are pertinent to the five-year survival rate figures? What we have been focusing on is the one-year figure as a means of driving forward earlier diagnoses, because it is largely at the one-year point that we are losing thousands of lives.

Jane Ellison: I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.
	On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.
	Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole
	cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.
	I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.
	Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.
	The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.
	Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.

John Glen: Does the Minister acknowledge that there is a difference between urban and rural in this context? While those who represent rural constituencies understand the need to aggregate services to get the specialism, we are also concerned about access. Is this not a careful judgment to be made?

Jane Ellison: I entirely agree; I think there is a balance to be struck. One of the issues that were discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was the issue of
	moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.
	Since 2010-11, the Department of Health has undertaken a series of local, regional and national “Be Clear on Cancer” campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further “Be Clear on Cancer” activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.
	Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.
	A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.
	Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.
	If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.
	My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.
	As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.
	On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.
	Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.
	Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.
	I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad
	On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have
	more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.
	Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.
	As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.

John Baron: I can probably accept that there may be good reasons for the delay, but perhaps even more importantly, will the Minister do what she can to ensure that the results of that survey, when it is eventually brought forward, are followed through for the benefit of patients? Too often, they are not and different CCGs are doing different things with the results.

Jane Ellison: Absolutely. That is the purpose of the buddying programme. There is now a more formalised process to ensure that those that are not doing so well are “buddied up” with those that are doing very well.
	I want to make a few more points in response to hon. Members’ comments. My hon. Friend rightly brought up the issue of CCG accountability and how we hold CCGs to account. I congratulate the APPG and his personal campaign to make sure we get the one-year cancer survival rates added to NHS England’s delivery dashboard from April this year. Where the evidence from the delivery dashboard is that local providers are not meeting the standards, that will be challenged by NHS England. I think there is still work to do to understand how we can do that most effectively. I know the APPG will also be giving thought to that. I encourage all local authorities, health and wellbeing boards and Members to be part of that challenge process. I also refer them to the work of the chief inspector of general practice, Professor Steve Field, in that regard, because that is an important part of his work, too.
	I can confirm that work is ongoing with regard to free social care at the end of life. The hon. Member for Easington asked about that. That work is ongoing, but the Minister with responsibility for care will be able to expand on that.
	On health and inequalities, I could not agree more with all hon. Members who made the point that tackling health inequalities is inextricable from tackling cancer effectively. I visited the constituency of the hon. Member for Nottingham North (Mr Allen) recently. The figures for how many cancers are diagnosed through the emergency route have been put on the record in this debate—around
	22%. He told me that in his constituency 40% of lung cancers are diagnosed in A and E, and they have very poor outcomes. That brought that point home to me extremely clearly.
	Sean Duffy, the national clinical director, is passionate about the treatment and care of older people affected by cancer. That can play a very significant role in improving our overall outcomes. I know that is something he wants to focus on through his call to action, as well as looking at lower socio-economic groups and some black and minority ethnic groups. A recent Be Clear on Cancer campaign on prostate cancer took place in six London boroughs and focused on black men and their particular susceptibility to that cancer.
	On rarer cancers, I have touched on some of the work that is going on, but I am pleased that Cancer Research UK’s new strategy launched last year set out how it would increase research in key areas such as early diagnosis, and again that work will feed into the taskforce.
	On research, I will not go into detail, but I invite my hon. Friend the Member for Castle Point to contact me at the Department of Health with regard to research on brain cancer. I was recently able to supply some very detailed figures to the all-party group on pancreatic cancer from the chief medical officer, and I would be very happy to supply them in her area of interest.
	Lastly, let me give some reassurance on access to data. Transparency is a key theme for this Government. We have rightly put huge amounts of data into the public domain. It is a frustration that the data availability issue to which my hon. Friend the Member for Basildon and Billericay referred has been hard to resolve. Last year some concerns were raised about the legitimacy of the release of patient data to a range of organisations. When these concerns were raised, Public Health England did absolutely the right thing and suspended the release of data while it conducted a full review. This review is now complete. Public Health England and the Health and Social Care Information Centre have also clarified the legal basis of data transfer between the organisations and a letter of authority has just been issued by the departmental sponsors to remove any ambiguity. Data should now begin flowing more quickly.
	I would like to thank all those who have contributed to this debate and to so many other debates we have had in the House on this vital subject. I strongly believe there is a great deal of consensus about what needs to happen. We need to continue to challenge the system, and I am delighted that Parliament continues to challenge Ministers in this regard. The new NHS England independent cancer taskforce is leading the way in partnership working and will make a real difference.
	If this is the last general debate we have on cancer in this Parliament, may I say thank you to the various APPGs and the people who speak for them, and give them the following assurance? I can tell them that, although it may not always seem like it, in the 18 months or so that I have been a Minister their work has made a difference, and I do know of things that have happened because APPGs and individual Members championed them in this place. If that does not give them the heart and encouragement to keep going and to come back in the new Parliament and champion these issues further, I do not know what will. I congratulate them on their efforts today, and on other days and throughout the year, on this highly important topic that matters so much to all our constituents.

John Baron: I am heartened that the Minister says we should keep going, and I assure her we will. Let me thank all hon. Members for their contributions. We have had some heartfelt ones, particularly from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). His contribution was very brave, and we have all said so. Other hon. Members have made heartfelt contributions about their own personal stories, including the hon. Member for Denton and Reddish (Andrew Gwynne). Let me also thank, as I did at the beginning, the cancer-specific all-party groups. The all-party group on cancer may consider itself the wider cancer community’s voice in Parliament, but we are all doing essential work that adds value to the debate, and I thank all concerned. We work together well and we are making a valuable contribution, as the Minister has kindly said.
	I thank the Minister and her team, as ever, for her constructive response. I asked one or two detailed questions in my opening speech that she has not had time to address, given the pressure of time, and I look forward to receiving a response in writing from her on those. May I leave one thought with her about improving outcomes, which is the subject of today’s debate? No one single measure will drive forward on the objective of improving outcomes. Science has its role to play. With my cancer hat on, courtesy of Cancer Research UK, I went to visit the Francis Crick building, the enormous building being constructed next to Euston station. It is inspiring to see that being built, and I was not the only one to feel that it will be a great source of hope in the future. Government initiatives will also take their place in improving cancer outcomes. My hon. Friend the Member for Salisbury (John Glen) made the point about standardised packaging, and, as the Minister well knows, I have made my support for that clear, as it is a step forward.
	However, there is one important measure—this is the thought I leave with the Minister—and one initiative that could be transformational in driving forward and improving cancer outcomes. I am talking about the one-year figures broken down by CCG, and the cancer community has come together in getting the Government successfully, together with NHS England, to put them in the top tier of NHS accountability. The Minister has admitted that there is a bit of vague ground on the levers of accountability and how NHS England will ensure that CCGs which underperform over a period of time will be brought to book. I suggest to her that if there is one measure that we will look back on in decades to come and say, “That, more than anything else, encouraged earlier diagnosis at a local level,” it is those one-year figures broken down by CCG. I encourage the Minister and the Department of Health, with NHS England, to do all they can to make sure that those levers of accountability are properly in place, so that we can save those extra thousands of lives, which is what we all wish for.
	Question put and agreed to.
	Resolved,
	That this House has considered improving cancer outcomes.

Business without Debate

BUSINESS OF THE HOUSE (10 FEBRUARY)

Ordered,
	That, at the sitting on Tuesday 10 February, the provisions of Standing Orders No. 16 (Proceedings under an Act or on European Union documents) and No. 41A (Deferred divisions) shall not apply to the Motion in the name of Secretary Theresa May relating to the Police Grant Report and the Motions in the name of Secretary Eric Pickles relating to Local Government Finance Reports, and the Speaker shall put the Questions necessary to dispose of proceedings on–
	(1) the Motion in the name of Secretary Theresa May relating to the Police Grant Report not later than three hours after the commencement of proceedings on that Motion, and
	(2) the Motions in the name of Secretary Eric Pickles relating to Local Government Finance not later than three hours after the commencement of proceedings on the first of those Motions or six hours after the commencement of proceedings relating to the Police Grant Report, whichever is the later; and proceedings on those Motions may continue, though opposed, after the moment of interruption.—(Dr Thérèse Coffey.)

Business of the House

Ordered,
	That, in respect of the House of Commons Commission Bill, notices of Amendments, new Clauses and new Schedules to be moved in Committee may be accepted by the Clerks at the Table before the Bill has been read a second time.—(Dr Thérèse Coffey.)

PETITION
	 — 
	Lack of Appropriate Parking around Shree Sanatan Mandir

Keith Vaz: I wish to present a petition of 373 concerned residents and worshippers of the Shree Sanatan Mandir temple in my constituency. The petition was collected by volunteers at the temple, led by Mr Ramanbhai Barber, the president of the trust, to call for urgent measures to increase accessibility and road safety around the temple. I also wish to thank Councillor Manjula Sood, the lord mayor of Leicester, John Thomas, and the prospective council candidate, Mo Chohan, for their support. The council has restored some bollards, but there is still much work to do.
	The petition states:
	The Petition of residents of Leicester East,
	Declares that the lack of parking, improper lighting and fast moving traffic around the Shree Sanatan Mandir is inconvenient and dangerous for worshippers and other road users. The temple has widespread links with communities across Leicester and holds many events and services for a large number of people. The Petitioners therefore request that the House of Commons urges the Leicester City Council to take action to increase safety and accessibility in the area, to allow visitors to reach their place of worship. The Petitioners require assurances that measures will include better parking and appropriate lighting, before any harm is caused by the current conditions.
	And the Petitioners remain, etc.
	[P001431]

BEER DUTY

Motion made, and Question proposed, That this House do now adjourn.—(DrThérèse Coffey.)

Andrew Griffiths: I am delighted to have secured this debate. I recognise that the final Adjournment debate of the week is not exactly the shift that every Minister wishes for, but I am delighted that she is here today for this important debate. It is important because I am the first MP for more than 10 years to be able to say that beer sales are on the up; beer sales are in growth. That is a direct result of the decision taken by the Chancellor and this Government to scrap the hated beer duty escalator, and to cut beer duty not once, but twice. It is those decisions that have led to the renaissance in brewing that we see at the moment.
	In this short Adjournment debate, I intend to make the case to the Minister about why she should complete a hat-trick that would be more memorable than Michael Owen’s hat-trick when he put three past Germany in that magnificent victory for England. I pay tribute to all the people who helped to deliver that important scrapping of the beer duty escalator, and those two cuts. In particular, I pay tribute to the Campaign for Real Ale and its 170,000 members who led the campaign, lobbied Parliament and their MPs, and made the case so vigorously on behalf of the brewing industry and the beer that they love so much.
	I also congratulate the British Beer and Pub Association that represents brewers and pub companies across the country, and the Society of Independent Brewers—SIBA. The Minister knows that there has been a renaissance in small brewers across the country. Some 1,700 brewers are now producing excellent beer across the country, and that is as a result of economic decisions taken by this Government as part of their long-term economic plan.
	I also wish to thank the TaxPayers Alliance, which ran the Mash the Beer Tax campaign, and TheSun newspaper. As we know, The Sun is always on the side of the hard-working man and woman in Britain, and it got behind this campaign to cut beer duty so that Britons could enjoy one of those simple pleasures: a pint of great British beer. The Minister will know about the great support that has been shown for this campaign by the Burton Mail—an august publication. I had the privilege of sending her the front page of the Burton Mail, which supports this campaign for the third cut in beer duty.

Tim Loughton: While revelling in the congratulations that my hon. Friend is dolling out left, right and centre, may I slightly rain on his parade? Although we are delighted with the abolition of the escalator, the last Budget, which of course introduced the 2% cut in beer duty and a freeze for spirits, actually increased duty on wine by 2.47%. As chairman of the all-party parliamentary wine and spirits group, may I ask whether he agrees that we need a better deal for wine drinkers as well?

Andrew Griffiths: I recognise the point that my hon. Friend makes, and I would be forced to agree with him as Mrs Griffiths is no stranger to a large pinot grigio. I
	point out that the campaign last time was led by a doughty Back Bencher who argued vociferously for cuts in alcohol duty, and I hope that there is some consistency in that argument in the weeks to come.
	I thank colleagues on both sides of the House. Although the hated beer duty escalator was Labour’s design, colleagues from all political parties supported the campaign. I would particularly like to pay tribute to members of the all-party parliamentary beer group, the all-party parliamentary save the pub group and, of course, my colleague the hon. Member for Leeds North West (Greg Mulholland), who was instrumental in that campaign.
	I am the MP for brewing. Burton is the home of British brewing, and some 5,873 people in my constituency are employed in beer and pubs. A thousand of them are young people, and it is interesting that this industry can offer great opportunities to the 16 to 25-year-olds the Government are trying to get into work and off the unemployment lists. The hospitality industry, and the pub industry in particular, represents a massive opportunity to help in that respect. I point out to the Minister that 1,136 people in Witham are employed in beer, pubs and brewing, so she will understand the issue’s importance.
	In my constituency, the gross value to the local economy is £348 million, and we contribute £438 million to the Treasury—something that, I am sure, delights the Minister. Nationally, the industry contributes £10 billion in taxation. At a time when we want to pay off the debt and pay down the deficit, that contribution must not be underestimated. Beer and pubs are vital to this country, and 1 million people rely on the beer and pub industry for their employment. I have alluded to the fact that 46% of those people are between the ages of 16 and 24.
	Beer is a success story. We brew the best beer in the world, and 82% of all the beer consumed in this country is brewed here by brewers big and small, producing a fantastic product. Although I understand the point made by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), wine is imported into this country—[Interruption]—ostensibly, but I have sampled, as has Mrs Griffiths, some fine English and Welsh wines.

Tim Loughton: I am delighted to hear about Mrs Griffiths’s delectation of fruit-based drinks for ladies, as I believe someone calls them. Is my hon. Friend aware that there are now 448 commercial vineyards and 131 wineries in the United Kingdom, and that the hectarage given over to vineyards here has more than doubled in the past 10 years, with 4.5 million bottles of excellent quality, world-beating English wine produced in this country and not imported?

Andrew Griffiths: I absolutely understand the points that my hon. Friend makes, but I gently point out that seven out of 10 drinks that are drunk in pubs are beer. If we value our community pubs, we can support them by supporting the great British brewing industry. Beer gets people into our community pubs, which are the backbone of our society, and each pub contributes £80,000 a year to the local economy. Of course, some of them offer other services—they are the post office, the local shop, and offer many facilities. We have heard of groups who have meals on wheels in their pubs. Pubs
	play an important role, and, as I have said before, they form the fabric of our community: the great British pub.

Peter Bottomley: I congratulate my hon. Friend on winning the beer award at the marvellous evening that we had on the Terrace. Will he join me in thanking the pub trade and the brewers for their help in reducing drink-driving while maintaining the social life of the pub, where more controlled, sensible and responsible drinking takes place than in many other places?

Andrew Griffiths: Indeed. If we want to tackle problem drinking, our community pubs are the solution, not the problem. Encouraging people back into the pub is the way to tackle that. My hon. Friend talks about publicans. According to Pub Aid, £120 million is raised for charity each year as result of people supporting initiatives in our pubs. We should all support that.
	When Labour’s hated beer duty escalator was introduced in 2008, we saw a duty increase of 42% in those few years. That hit beer sales, made pints less affordable and closed pubs. If we care about pubs, that should worry us.

Peter Bottomley: A very short point, and it is not supposed to be too pointed—it is interesting that there is not a single Labour Member present for this important debate on beer.

Andrew Griffiths: I recognise the point that my hon. Friend makes. It is not lost on me that it was Labour that introduced the beer duty escalator, but as I said, many MPs on all sides supported the campaign for its abolition.
	When the beer duty escalator was introduced, beer consumption fell by 16% across the board, and in pubs it fell by 25%. The decision by that Labour Government closed pubs—7,000 of them—and we lost 58,000 beer-related jobs as a result. The amazing thing is that although beer duty increased by 42%, beer duty revenue to the Treasury increased by only 12%. We can see the impact that the escalator had not only on our pubs and our brewers, but on the Treasury take—the goose that laid the golden egg and that Labour Chancellor choked it. We can see the folly of the escalator.
	When the current Chancellor chose to scrap the beer duty escalator in 2013 and cut beer duty for the first time since 1958, he was cheered by 32 million beer drinkers across the country and 170,000 CAMRA members who had worked so hard to bring that about. Last year we saw that historic second cut in beer duty. My right hon. Friend was the first Chancellor in history to cut beer duty in two successive Budgets and I commend him for it. The cut was passed on by the industry. There are some who try to suggest that brewers or pub companies did not pass it on to their customers, but we have seen the lowest increase in beer prices since the 1980s—just 2.2%. When, as we are often told, we are suffering from a crisis in the cost of living, the fact that the Chancellor cut beer duty and therefore delivered lower beer prices so that hard-working men and women could enjoy one of life’s simple pleasures, is important.
	Consequently, as I said earlier, we have seen a growth in beer sales for the first time in 10 years. That means brewers, publicans and all the related trades having business through their doors and are on the up, which must be good news. According to the British Beer and Pub Association, those two duty cuts and ending the escalator saved 16,000 jobs. Most importantly, confidence in the industry is up, confidence in the Government is up, and as a result some £1.1 billion is likely to be invested over the next 12 months. In my constituency I have seen the impact. Molson Coors is investing £75 million in its brewery in Burton, and Marston’s has invested over £20 million in its bottling plant in Burton. That is not just brewers on the up, but engineering and manufacturing—another success story.
	When we made the case to the Chancellor two years ago, we said, “Cut beer duty and beer sales will go up; cut beer duty and the Treasury’s tax take will increase.” In results that would make Jonathan Isaby of the TaxPayers Alliance dance around his office in glee, we have proven that lower taxes for the brewing industry result in a better return for the Treasury. Even sales in pubs, which we have all been concerned about, have declined by less than 1% over the past 12 months. That is clear evidence that we are beginning to see a change, with investment and growth in our pubs. The last time we saw such a performance was in 1996, and strangely enough that was the last time we had a Conservative Government—cause and effect.
	What has been the result for the Treasury’s tax take? Over the 12 months to November 2014, beer duty revenue actually increased by £39 million, and it is £15 million higher than it was in March 2014. Add the additional VAT and jobs-related taxes and we can see that cutting beer duty is great news for the Treasury. The Government have also cut business rates, helped with apprenticeships, and followed a long-term economic plan that is supporting small businesses. That all means the brewing industry and the pub industry have a great deal more confidence and are on the up.
	However, hard-pressed British beer drinkers still pay 40% of all Europe’s beer duty, despite drinking only 13% of the beer. If we could cut beer duty just a little more, we would see more great British products being consumed. Of course, we are now exporting that great British product around the world, not only to France, Germany and other European countries, but to Japan and China. The industry has massive potential.
	Madam Deputy Speaker, having listened to the facts and the evidence, I am sure you will agree that the Minister must now be thinking, “Why on earth wouldn’t I cut beer duty a third time?” The economic case, the social case and the jobs case have all been made. However, I want to remind her of one final consideration that she might not be aware of: her last two predecessors who decided to cut beer duty are now in the Cabinet—cause and effect. Cutting beer duty is good for the Treasury, good for the industry and good for our communities. I am sure that she is listening, and I hope that we will see a hat-trick in the Budget this year.

Priti Patel: I congratulate my hon. Friend the Member for Burton (Andrew Griffiths) not only on securing this debate, but on the reward he received this week for his lobbying and
	campaigning on behalf of the beer industry. I pay tribute to him for campaigning solidly over this Parliament on behalf of his constituents in Burton, the home of British brewing. He is a champion of the jobs, the investment and the economic security that the industry has provided. I also commend the passion he has shown in his work as chair of the all-party group on beer. It is one of the most popular all-party groups, unsurprisingly, given the effective leadership he has displayed. It has been a delight to work with him on various issues, both before and since becoming a Minister.
	This week UK beer sales have increased for the first time in 10 years. That is a testament to the hard work that my hon. Friend has put in over the years in standing up for the beer and pub industries. The great British pub and great British brewers are institutions that we in Government wholeheartedly support. As we heard in the compelling case eloquently made by my hon. Friend, there is a very strong argument that the brewing and pub sector is a major part of the UK economy. It adds £22 billion to the UK’s GDP. It directly employs over 600,000 people and supports almost 900,000 people in total, including, as he said, a significant proportion of young people. There is a very strong skills base in the industry, and young people are part of that. As he said, it also boosts British manufacturing, and its exports are worth over £630 million.
	Perhaps as importantly, pubs have been at the heart of British culture for centuries. Fifteen million people visit them each week. They are the cornerstone of our communities, and of tourism. As Members of Parliament, we all recognise that they play a strong and pivotal role in our local communities, particularly rural ones.

Andrew Griffiths: The Minister mentions tourism. Is she aware that visiting a great British pub is one of the key things that visitors to this country want to do when they arrive on these shores? Does she agree that we should be doing more to promote the great British pub as part of our tourism offer?

Priti Patel: My hon. Friend is absolutely right. We have spoken about this at the APPG. The pub is absolutely pivotal to boosting Great Britain’s brand. Tourism and our rural economies are part of that. When we speak about pubs, it is about enjoyment—the fact that people enjoy them. As a policy maker and a Minister, I sometimes think that that is not sufficiently taken into account.
	The case for supporting pubs and brewers as institutions is overwhelming. We see that across the country, beyond pubs, in the supply chain and the wider industry. Maltings and other factors in the supply chain are crucial and pivotal to our economy.

Tim Loughton: My hon. Friend the Member for Burton (Andrew Griffiths) made a fantastic economic case for the beer industry that the Minister is fortunately echoing. Will she apply the same criteria to the wine industry, which accounts for some 22% of sales in pubs and restaurants, accounts for no less than 67% of all the wine duty paid in the whole of the EU, and contributes £3.7 billion to the Exchequer? Will she see a delegation from the all-party group on wine and spirits, led by me? If we can combine that with happy hour at the Treasury, I will gladly bring along a bottle of Nyetimber, Ridgeview, or my favourite champenois, Breaky Bottom—“Probably the best bottom in the world”, as it markets itself.

Priti Patel: Of course, the answer is yes to the delegation. My hon. Friend is right that the wine industry makes an enormous economic contribution. Earlier, he referred to English wines. I speak proudly as the Member of Parliament for Witham as I, too, have a good vineyard in my constituency. The wine sector is to be supported and commended as well. I will take him up on his offer; he is very welcome to come and meet me at the Treasury.
	As my hon. Friend the Member for Burton pointed out, the previous Government’s beer duty escalator hit the industry hard. It led to pub closures and cost people their jobs. Of course, we have made changes to the escalator. In recognition of what happened in the past, we went on to cut tax on a typical pint of beer by one penny at Budget 2013 and another penny at Budget 2014. I am delighted that he celebrates the fact that the duty on a typical pint of beer is now 8p lower than under the previous Government’s plan. According to the British Beer and Pub Association, the jobs of 16,000 people have been secured by our duty cuts, and for them the duty cuts have been fundamental to their livelihoods. The duty cuts have also boosted confidence in the brewing and pub sector and, importantly, they have led to greater investment and greater economic security when it comes to jobs.
	Research for the British Beer and Pub Association estimates that an additional 186 million pints will be sold in the on-trade this year as a result of our beer duty cuts. To meet that increase, it estimates that there has been a 12% rise in investment—in monetary terms, an additional £44 million—in the sector in the last year directly as a result of the cut in duty. According to a recent survey, 86% of its members are planning to increase their investment in the UK. That strengthens our economic case, and shows that we are serious about supporting the pub sector.
	As my hon. Friend said, nearly two thirds of all the alcohol sold in pubs is beer, but other drinks are important to pubs. To ensure that help is extended to pubs that have diversified away from beer, at Budget 2014 we froze duties on spirits and ordinary cider. Of course, we ended the escalator on wine as well; I am somewhat familiar with the campaign in favour of that.
	Pubs are benefiting from the wider changes that the Government have made to support business. Three quarters of pubs are benefiting from a £1,000 reduction in their business rates this year. The reduction will rise to £1,500 next year. We have extended the doubling of small business rate relief to April 2016, which, as my hon. Friend knows, will particularly help the eight out of 10 pubs run as individual small businesses. Pubs will benefit from our national insurance changes. The £2,000 employment allowance has reduced employer national insurance contributions for all businesses. Pubs will also benefit from the reduction in employer NICs for young people, which is particularly important because 46% of the people employed in pubs are aged between 18 and 24. We have introduced regulatory changes to make it easier for pubs to play live music, and to allow beer and wine to be served in glasses of different sizes.
	As I am sure my hon. Friend will know, there no such thing as a typical pub. There are as many different types of pub as there are types of customer, so pubs should have the flexibility to meet customers’ needs. It is fair to say that customers want reasonably priced drinks, naturally, and I am glad to say that our duty cuts are translating
	directly into more beer for your buck. Beer prices in the on-trade are rising at their lowest rate for more than 25 years: 96% of British Beer and Pub Association members have said that they plan to reduce or freeze their prices as a result of our policies. That is fantastic news for the 32 million people in the UK who drink beer each year; incidentally, that is more than the number of people who voted in the last general election.
	Our customers want choice. It is great news that more than three quarters of respondents to the British Beer and Pub Association survey intend to launch new products directly as a result of the cut in beer duty. Small brewers relief has reduced the beer duty paid by micro-brewers by up to a half. That has encouraged new micro-breweries to be set up and to expand. There are now 1,000 more breweries in the UK than in the year before small brewers relief was introduced.
	I am particularly interested in how we can do more to help those industries, because there are many associated benefits from having more thriving breweries, not just in exports, but in the tourism offer, as my hon. Friend has said.

Peter Bottomley: Regional brewers also matter. Will my hon. Friend allow me to pay tribute to Hall & Woodhouse, which is one of the many? It set up the community chest in Dorset and West Sussex, which gives grants to good organisations. Not all of the organisations are run in the pubs, but the pubs and brewers want to support them.

Priti Patel: My hon. Friend is absolutely right. Regional brewers play an important role by bringing diversity to the mix and by making a contribution. When there is a range of thriving breweries, with regional aspects as well, it provides differentiation and helps with tourism, because it makes regions attractive to people and brings them in.
	I want to touch on the big societal changes that we have seen over the past few years. People give a lot more consideration to what they are drinking. They take an interest not only in what they drink, but in how it is produced. With some notable exceptions, people are much more knowledgeable about responsible drinking and regional varieties. Every landlord knows that any drink is capable of being enjoyed in a responsible way or of being misused. This Government will always argue against the top-down approach. I pay tribute to the industry for everything that it has done on responsible drinking and to pubs for the role that they have played in promoting responsible behaviour. We have seen successful schemes, such as the highly renowned Best Bar None.
	My hon. Friend the Member for Burton has spoken eloquently about continued action through the tax system to ensure that pubs and breweries continue. I commend him for his speech today.
	House adjourned without Question put (Standing Order No. 9(7)).